Provider Demographics
NPI:1962236711
Name:BLANC, AMANDA NICOLE (RBT-23-273640)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE
Last Name:BLANC
Suffix:
Gender:F
Credentials:RBT-23-273640
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7065 MISTFLOWER LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5843
Mailing Address - Country:US
Mailing Address - Phone:945-243-0333
Mailing Address - Fax:
Practice Address - Street 1:450 INDEPENDENCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8016
Practice Address - Country:US
Practice Address - Phone:469-573-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-23-273640106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician