Provider Demographics
NPI:1356686000
Name:BEHRENDT, AMANDA (LCPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BEHRENDT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MINERAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6271
Mailing Address - Country:US
Mailing Address - Phone:406-522-6408
Mailing Address - Fax:406-522-6474
Practice Address - Street 1:2413 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3807
Practice Address - Country:US
Practice Address - Phone:406-219-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health