Provider Demographics
NPI:1093022030
Name:DURDIN, AMANDA LYNN (BA, BCABA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LYNN
Last Name:DURDIN
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SMITH LN
Mailing Address - Street 2:
Mailing Address - City:BRUCEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76630-3256
Mailing Address - Country:US
Mailing Address - Phone:254-716-8743
Mailing Address - Fax:
Practice Address - Street 1:1103 SMITH LN
Practice Address - Street 2:
Practice Address - City:BRUCEVILLE
Practice Address - State:TX
Practice Address - Zip Code:76630-3256
Practice Address - Country:US
Practice Address - Phone:281-705-3095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-10-3841103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst