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General NPI Number Information
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NPI Number | 1841938024
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Entity Type | Individual
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Provider Name | SPANDANA MAITRA LPC
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Gender | Female
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Dates
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Enumeration Date | 05/26/2022
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 5601 DEMOCRACY DR STE 255
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City | PLANO
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State | TX
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Zip | 75024-3699
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Country | US
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Telephone | 940-765-9029
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Fax |
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Provider Business Mailing Address
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Address Line | 536 INDIAN CREEK DR
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City | TROPHY CLUB
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State | TX
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Zip | 76262-9738
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Country | US
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Telephone | 817-526-2857
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 84838
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License Number State | TX
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