Provider Demographics
NPI:1144881632
Name:PARKS, AMANDA (MED, CRC, LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:MED, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 N HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2129
Mailing Address - Country:US
Mailing Address - Phone:702-715-2599
Mailing Address - Fax:
Practice Address - Street 1:1326 N HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2129
Practice Address - Country:US
Practice Address - Phone:702-715-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1791101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional