Provider Demographics
NPI:1144457292
Name:PETERMAN, AMANDA D (LCMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:PETERMAN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 W 87TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-4628
Mailing Address - Country:US
Mailing Address - Phone:913-662-1013
Mailing Address - Fax:913-371-0664
Practice Address - Street 1:10100 W 87TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-4628
Practice Address - Country:US
Practice Address - Phone:913-662-1013
Practice Address - Fax:913-371-0664
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS907106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist