Provider Demographics
NPI:1508237645
Name:ELISEO, AMANDA JOAN (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOAN
Last Name:ELISEO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JOAN
Other - Last Name:KRAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:914 E GURLEY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3245
Mailing Address - Country:US
Mailing Address - Phone:928-899-9677
Mailing Address - Fax:
Practice Address - Street 1:914 E GURLEY ST STE 200
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3245
Practice Address - Country:US
Practice Address - Phone:928-899-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15329101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor