MEDICARE: AMBER ANDERSON

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	74246	TX

General Provider Information

NPI Number	:	1225789860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ANDERSON

Provider Business Mailing Address
First Line	:	4433 SIERRA DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-3121
Country	:	US
Telephone Number	:	972-249-5409
Fax Number	:

Provider Business Practice Location Address
First Line	:	8140 WALNUT HILL LN STE 320
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4328
Country	:	US
Telephone Number	:	469-458-0157
Fax Number	:

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

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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Directions to “ AMBER ANDERSON ” Practice Location

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