Provider Demographics
NPI:1316597040
Name:SAUVILLER, AMANDA DAWN (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:SAUVILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S POTTAWATOMIE RD
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-5933
Mailing Address - Country:US
Mailing Address - Phone:405-388-2339
Mailing Address - Fax:
Practice Address - Street 1:701 CEDAR LAKE BLVD STE 134
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-7816
Practice Address - Country:US
Practice Address - Phone:405-388-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10671101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional