Provider Demographics
NPI:1114368792
Name:WOOD, AMANDA LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LOUISE
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29551 MONARCH DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1423
Mailing Address - Country:US
Mailing Address - Phone:949-362-0079
Mailing Address - Fax:
Practice Address - Street 1:27285 LAS RAMBLAS STE 140
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8551
Practice Address - Country:US
Practice Address - Phone:949-257-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20304103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical