MEDICARE: AMANDA KATHLEEN DENNIS LCSW

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	1041C0700X	Clinical Social Worker	33447	TX

General Provider Information

NPI Number	:	1740733542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KATHLEEN DENNIS LCSW

Provider Business Mailing Address
First Line	:	8203 SCORESBY MANOR CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5318
Country	:	US
Telephone Number	:	713-458-8598
Fax Number	:

Provider Business Practice Location Address
First Line	:	8203 SCORESBY MANOR CT
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-5318
Country	:	US
Telephone Number	:	713-458-8598
Fax Number	:

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

Provider Enumeration Date	:	07/27/2016
Last Update Date	:	07/27/2016

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