Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 1269 | SC |
N | 103TC0700X | Clinical Psychologist | 1269 | SC |
Y | 103G00000X | Clinical Psychologist | 38459 | TX |
Y | 103TC0700X | Clinical Psychologist | 38459 | TX |
N | 103TC1900X | Counseling Psychologist | NOO-353-270 | KY |
NPI | 1013148360 |
---|---|
Provider Name | Amanda Eberle |
First Address | Houston, TX 77081-1107 |
Second Address | Humble, TX 77338-3934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 01/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
413475101 | (05) | TX |