Provider Demographics
NPI:1609150325
Name:GALER, AMANDA BANKS (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BANKS
Last Name:GALER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63484 LIGHTNING RD
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-3896
Mailing Address - Country:US
Mailing Address - Phone:859-878-2176
Mailing Address - Fax:
Practice Address - Street 1:63484 LIGHTNING RD
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3896
Practice Address - Country:US
Practice Address - Phone:859-878-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI20022921041C0700X
ORL138021041C0700X
KYKY37731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100300280Medicaid
OH0160547Medicaid