Provider Demographics
NPI:1245565290
Name:TODD, AMANDA L (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:TODD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 W GORE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6328
Mailing Address - Country:US
Mailing Address - Phone:580-250-5983
Mailing Address - Fax:580-250-6696
Practice Address - Street 1:3811 W GORE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6328
Practice Address - Country:US
Practice Address - Phone:580-250-5983
Practice Address - Fax:580-250-6696
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist