Provider Demographics
NPI:1538850508
Name:AYALA, AMANDA E (ASSOCIATE)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:E
Last Name:AYALA
Suffix:
Gender:F
Credentials:ASSOCIATE
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASSOCIATE
Mailing Address - Street 1:1300 JOHN ADAMS ST STE 133
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1695
Mailing Address - Country:US
Mailing Address - Phone:503-208-4014
Mailing Address - Fax:503-455-4219
Practice Address - Street 1:1300 JOHN ADAMS ST STE 133
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1695
Practice Address - Country:US
Practice Address - Phone:503-208-4014
Practice Address - Fax:503-455-4219
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6414106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist