Healthcare Provider Details

I. General information

NPI: 1265734826
Provider Name (Legal Business Name): AMANDA LYNN ZOLD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 09/06/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5615 H. MARK CROSSWELL JR. ST
HOUSTON TX
77021
US

IV. Provider business mailing address

2800 S MACGREGOR WAY
HOUSTON TX
77021-1032
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-7341
  • Fax: 860-545-7510
Mailing address:
  • Phone: 713-741-5000
  • Fax: 713-741-6909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3989
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number39433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: