MEDICARE: MRS. AMANDA GEILENFELDT LPC

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	78000	TX

General Provider Information

NPI Number	:	1346850062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA GEILENFELDT LPC

Provider Business Mailing Address
First Line	:	1613 LARRY WADKINS DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5218
Country	:	US
Telephone Number	:	505-228-6489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 LARRY WADKINS DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-5218
Country	:	US
Telephone Number	:	505-228-6489
Fax Number	:

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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