Provider Demographics
NPI:1437393576
Name:NELSON-GERUNTHO, AMANDA L (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:NELSON-GERUNTHO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9432
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99209-9432
Mailing Address - Country:US
Mailing Address - Phone:503-395-7547
Mailing Address - Fax:
Practice Address - Street 1:1903 W GARLAND AVE STE 9432
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2519
Practice Address - Country:US
Practice Address - Phone:503-395-7547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60452414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60452414OtherWA STATE DEPT OF HEALTH