Individual
AMANDA GAYLE IBANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
150 HILLCREST MEDICAL BLVD, WACO, TX 76712-8897
(254) 202-4056
Mailing address
605 AUSTIN AVE STE 105, WACO, TX 76701-2048
(254) 722-6958
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
57225
TX
1041C0700X
Clinical Social Worker
Primary
57225
TX
Other
Enumeration date
06/27/2017
Last updated
12/11/2023
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