Provider Demographics
NPI:1215473665
Name:ANDRA, AMY LYNN (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:ANDRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 NELSON WYATT RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6060
Mailing Address - Country:US
Mailing Address - Phone:817-718-2477
Mailing Address - Fax:
Practice Address - Street 1:5431 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-4836
Practice Address - Country:US
Practice Address - Phone:972-775-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional