Provider Demographics
NPI:1518361633
Name:HENRIE, AMANDA
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:HENRIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 PORTOLA DR
Mailing Address - Street 2:
Mailing Address - City:DEL REY OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5539
Mailing Address - Country:US
Mailing Address - Phone:928-587-1291
Mailing Address - Fax:
Practice Address - Street 1:604 PEARL ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3070
Practice Address - Country:US
Practice Address - Phone:831-647-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M0000XOtherBEHAVIORAL HEALTH AIDE MHS