Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 14025 | TX |
NPI | 1003327305 |
---|---|
Provider Name | Amanda Papenfus |
First Address | Round Rock, TX 78664-3289 |
Second Address | Round Rock, TX 78664-3289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2017 |
Last Update Date | 13/10/2017 |