Provider Demographics
NPI:1316600083
Name:DEVRIES, AMANDA R (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:R
Last Name:DEVRIES
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 1:705 E 41ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6047
Mailing Address - Country:US
Mailing Address - Phone:605-444-7643
Mailing Address - Fax:605-444-7690
Practice Address - Street 1:1424 9TH AVE SE STE 7
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-5361
Practice Address - Country:US
Practice Address - Phone:605-882-2740
Practice Address - Fax:605-882-4323
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20603101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor