Healthcare Provider Details

I. General information

NPI: 1467923318
Provider Name (Legal Business Name): AMANDA DAVIDSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/21/2026
Certification Date: 02/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11940 JOLLYVILLE RD 110S
AUSTIN TX
78759
US

IV. Provider business mailing address

7300 HART LANE
AUSTIN TX
78731-2407
US

V. Phone/Fax

Practice location:
  • Phone: 512-250-1043
  • Fax: 512-257-7179
Mailing address:
  • Phone: 512-250-1043
  • Fax: 512-257-7179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76751
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number76751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: