MEDICARE: AMANDA NICOLE BLANC

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	103K00000X	Behavior Analyst	1-26-87492	TX

General Provider Information

NPI Number	:	1962236711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA NICOLE BLANC

Provider Business Mailing Address
First Line	:	7065 MISTFLOWER LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-5843
Country	:	US
Telephone Number	:	945-243-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 SPRING VALLEY RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-3616
Country	:	US
Telephone Number	:	972-674-8477
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	02/05/2026

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Directions to “ AMANDA NICOLE BLANC ” Practice Location

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