Provider Demographics
NPI:1063023588
Name:BARTHELMES, AMANDA (MMFT-TRAINEE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BARTHELMES
Suffix:
Gender:F
Credentials:MMFT-TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GATEWAY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3306
Mailing Address - Country:US
Mailing Address - Phone:916-645-3300
Mailing Address - Fax:
Practice Address - Street 1:110 GATEWAY DR STE 210
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-3306
Practice Address - Country:US
Practice Address - Phone:916-645-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist