Provider Demographics
NPI:1255680740
Name:MOE, AMANDA L (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:MOE
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRESBYTERIAN MEDICAL SERVICES
Mailing Address - Street 2:184 UNSER BLVD NE
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-962-6649
Mailing Address - Fax:
Practice Address - Street 1:PRESBYTERIAN MEDICAL SERVICES
Practice Address - Street 2:184 UNSER BLVD. NE
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2601
Practice Address - Country:US
Practice Address - Phone:505-962-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0184171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health