Healthcare Provider Details

I. General information

NPI: 1003426560
Provider Name (Legal Business Name): CRYSTAL AMADOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 BEDFORD RD STE 200
BEDFORD TX
76021-7016
US

IV. Provider business mailing address

2012 BEDFORD RD STE 200
BEDFORD TX
76021-7016
US

V. Phone/Fax

Practice location:
  • Phone: 817-435-2031
  • Fax: 817-585-4067
Mailing address:
  • Phone: 817-435-2031
  • Fax: 817-585-4067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number78751
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: