Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TH0100X | Health Service |
NPI | 1437767639 |
---|---|
Provider Name | Dr. Amanda Proctor |
First Address | Addison, TX 75001-3613 |
Second Address | Addison, TX 75001-3613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |