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NPI Code Detail

MEDICARE: AMANDA TYNES LPA

MEDICARE: AMANDA TYNES LPA
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
1101YM0800XMental Health Counselor30548TX

General Provider Information

NPI Number : 1770417594
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA TYNES LPA
Provider Business Mailing Address
First Line : 11882 GREENVILLE AVE STE 107
Second Line :
City : DALLAS
State : TX
Zip : 75243-3567
Country : US
Telephone Number : 972-644-8686
Fax Number : 972-644-8688
Provider Business Practice Location Address
First Line : 11882 GREENVILLE AVE STE 107
Second Line :
City : DALLAS
State : TX
Zip : 75243-3567
Country : US
Telephone Number : 972-644-8686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2026
Last Update Date : 06/09/2026

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Directions to “ AMANDA TYNES LPA” Practice Location

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