Provider Demographics
NPI:1558143438
Name:DURAN, AMANDA BARBARA (MFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BARBARA
Last Name:DURAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:BARBARA
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1440 BEAUMONT AVE STE A2-212
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-6820
Mailing Address - Country:US
Mailing Address - Phone:951-880-7365
Mailing Address - Fax:
Practice Address - Street 1:6800 INDIANA AVE STE 130
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4266
Practice Address - Country:US
Practice Address - Phone:951-217-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142032106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist