Provider Demographics
NPI:1548531957
Name:MOATES, AMANDA FRANCES (PHD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:FRANCES
Last Name:MOATES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 SPRING VALLEY RD
Mailing Address - Street 2:STE 1100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3631
Mailing Address - Country:US
Mailing Address - Phone:972-404-8325
Mailing Address - Fax:972-404-8326
Practice Address - Street 1:4201 SPRING VALLEY RD
Practice Address - Street 2:STE 1100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3631
Practice Address - Country:US
Practice Address - Phone:972-404-8325
Practice Address - Fax:972-404-8326
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35197103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist