=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851824031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA LYNN PRATER MRC, LPC, BCB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2017
-----------------------------------------------------
Last Update Date | 04/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 670 W ARAPAHO RD SUITE 5
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-437-9177
-----------------------------------------------------
Fax | 972-437-9201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 670 W ARAPAHO RD SUITE 5
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-437-9177
-----------------------------------------------------
Fax | 972-437-9201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 71937
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------