Provider Demographics
NPI:1235473992
Name:THOMAS, AMANDA LEE (MPHED, MFTI)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MPHED, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S 1ST AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1398
Mailing Address - Country:US
Mailing Address - Phone:303-775-1779
Mailing Address - Fax:208-263-0951
Practice Address - Street 1:102 S 1ST AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1398
Practice Address - Country:US
Practice Address - Phone:303-775-1779
Practice Address - Fax:208-263-0951
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFTI-4296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist