Provider Demographics
NPI:1902261969
Name:HEANEY, AMANDA
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HEANEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 NW 63RD ST STE 160
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3607
Mailing Address - Country:US
Mailing Address - Phone:405-259-7443
Mailing Address - Fax:405-421-0719
Practice Address - Street 1:3033 NW 63RD ST STE 160
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116
Practice Address - Country:US
Practice Address - Phone:405-259-7443
Practice Address - Fax:405-421-0719
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200323940Medicaid