Provider Demographics
NPI:1114647138
Name:MAGNUSON, AMANDA (MA AMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MAGNUSON
Suffix:
Gender:F
Credentials:MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 BROOKVIEW MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:96008-9733
Mailing Address - Country:US
Mailing Address - Phone:530-638-2527
Mailing Address - Fax:
Practice Address - Street 1:1650 OREGON ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1701
Practice Address - Country:US
Practice Address - Phone:530-638-2527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist