Healthcare Provider Details

I. General information

NPI: 1053692533
Provider Name (Legal Business Name): AMANDA SKONETSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2011
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N LAMAR BLVD STE E121
AUSTIN TX
78751-1074
US

IV. Provider business mailing address

1509 W NORTH LOOP BLVD
AUSTIN TX
78756-2004
US

V. Phone/Fax

Practice location:
  • Phone: 512-698-2633
  • Fax:
Mailing address:
  • Phone: 512-698-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: