MEDICARE: AMANDA C NELSON LPC-ASSOCIATE, M.A.

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	101YM0800X	Mental Health Counselor	95619	TX

General Provider Information

NPI Number	:	1205673852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA C NELSON LPC-ASSOCIATE, M.A.

Provider Business Mailing Address
First Line	:	1102 CUSTER PASS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 CUSTER PASS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3421
Country	:	US
Telephone Number	:	210-307-9564
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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