Provider Demographics
NPI:1407213523
Name:KLOTZ, AMANDA (MS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 MARINA POINTE VILLAGE CT
Mailing Address - Street 2:APT 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-9036
Mailing Address - Country:US
Mailing Address - Phone:813-486-8313
Mailing Address - Fax:
Practice Address - Street 1:6601 MARINA POINTE VILLAGE CT
Practice Address - Street 2:APT 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-9036
Practice Address - Country:US
Practice Address - Phone:813-486-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health