Healthcare Provider Details

I. General information

NPI: 1306142237
Provider Name (Legal Business Name): AMANDA HUFFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 EXECUTIVE CENTER DR BLDG. 11, STE. 265
AUSTIN TX
78731-1645
US

IV. Provider business mailing address

3721 EXECUTIVE CENTER DR BLDG. 11, STE. 265
AUSTIN TX
78731-1645
US

V. Phone/Fax

Practice location:
  • Phone: 512-964-1555
  • Fax: 512-870-9771
Mailing address:
  • Phone: 512-964-1555
  • Fax: 512-870-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number50134
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: