Provider Demographics
NPI:1548060452
Name:DAVIS, AMANDA FERN (MPSS)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:FERN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:COLUSA
Mailing Address - State:CA
Mailing Address - Zip Code:95932-2950
Mailing Address - Country:US
Mailing Address - Phone:530-458-0799
Mailing Address - Fax:
Practice Address - Street 1:124 E WEBSTER ST
Practice Address - Street 2:
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2950
Practice Address - Country:US
Practice Address - Phone:530-458-0799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-TXZYVE175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist