Provider Demographics
NPI:1467126615
Name:AMANDA CLEMONS PARENTING THERAPY
Entity Type:Organization
Organization Name:AMANDA CLEMONS PARENTING THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:509-362-5933
Mailing Address - Street 1:3120 S GRAND BLVD UNIT 8473
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2681
Mailing Address - Country:US
Mailing Address - Phone:509-362-5933
Mailing Address - Fax:509-570-5155
Practice Address - Street 1:405 E HARTSON AVE STE 7
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1329
Practice Address - Country:US
Practice Address - Phone:509-362-5933
Practice Address - Fax:509-847-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2050425Medicaid