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General NPI Number Information
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NPI Number | 1831753664
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Entity Type | Individual
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Provider Name | AMANDA RUSSO LPC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1701 E 15TH ST
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City | PLANO
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State | TX
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Zip | 75074-6436
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Country | US
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Telephone | 972-693-4444
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261742
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City | PLANO
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State | TX
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Zip | 75026-1742
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Country | US
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Telephone |
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 74419
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License Number State | TX
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