Provider Demographics
NPI:1497491559
Name:AMANDA WISSLER COUNSELING, PLLC
Entity Type:Organization
Organization Name:AMANDA WISSLER COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-448-8264
Mailing Address - Street 1:6749 N 2200 W APT B103
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-8305
Mailing Address - Country:US
Mailing Address - Phone:801-448-8264
Mailing Address - Fax:
Practice Address - Street 1:2078 PROSPECTOR AVE STE 1
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7587
Practice Address - Country:US
Practice Address - Phone:801-448-8264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty