MEDICARE: AMANDA DE LA LLATA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	03703	KS
2	101YP2500X	Professional Counselor	68522	TX

General Provider Information

NPI Number	:	1033072947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DE LA LLATA

Provider Business Mailing Address
First Line	:	1306 TEXAS OAKS CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-6346
Country	:	US
Telephone Number	:	512-706-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 MENCHACA RD STE 805
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-5379
Country	:	US
Telephone Number	:	512-706-5677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ AMANDA DE LA LLATA ” Practice Location

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