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General NPI Number Information
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NPI Number | 1073820817
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Entity Type | Individual
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Provider Name | AMANDA SOISSON NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 4200 SOUTH FWY SUITE 602
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City | FORT WORTH
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State | TX
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Zip | 76115-1400
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Country | US
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Telephone | 214-402-8302
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Fax | 817-923-2063
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Provider Business Mailing Address
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Address Line | 17480 DALLAS PKWY SUITE 230
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City | DALLAS
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State | TX
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Zip | 75287-7337
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Country | US
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Telephone | 214-402-8302
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Fax | 972-407-1305
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19753
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License Number State | TX
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