MEDICARE: AMANDA OWEN UNDERWOOD M.A., LPC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	19882	TX
2	101YP2500X	Professional Counselor	19882	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1306304134	OTHER		NPI2 FOR AMANDA OWEN COUNSELING SERVICES PLLC

General Provider Information

NPI Number	:	1497881304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA OWEN UNDERWOOD M.A., LPC-S

Provider Business Mailing Address
First Line	:	3615 FOXBORO LN
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2937
Country	:	US
Telephone Number	:	469-767-6888
Fax Number	:	972-848-9777

Provider Business Practice Location Address
First Line	:	6010 W SPRING CREEK PKWY STE 232
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-3569
Country	:	US
Telephone Number	:	469-767-6888
Fax Number	:	972-848-9777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	01/10/2022

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