Provider Demographics
NPI:1114459369
Name:MILEDA, AMANDA ROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ROSE
Last Name:MILEDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ROSE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23236 LYONS AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5014
Mailing Address - Country:US
Mailing Address - Phone:818-835-2091
Mailing Address - Fax:
Practice Address - Street 1:23236 LYONS AVE STE 212
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5014
Practice Address - Country:US
Practice Address - Phone:818-835-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF98227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist