Provider Demographics
NPI:1679873079
Name:VAIL, AMANDA PAIGE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PAIGE
Last Name:VAIL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NASA PKWY
Mailing Address - Street 2:1227
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3246
Mailing Address - Country:US
Mailing Address - Phone:713-204-0955
Mailing Address - Fax:
Practice Address - Street 1:2727 NASA PKWY
Practice Address - Street 2:1227
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3246
Practice Address - Country:US
Practice Address - Phone:713-204-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical