Basic Information
| Provider Information | |||||||||
| NPI: | 1245595594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXWELL | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | STEVENSON | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 524 E SPRING VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750815103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145427561 | ||||||||
| FaxNumber: | 9722380631 | ||||||||
| Practice Location | |||||||||
| Address1: | 4545 FULLER DR STE 325 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728705511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2012 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 31136 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.