Provider Demographics
NPI:1609536234
Name:MIN, AMANDA REED (AMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:REED
Last Name:MIN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PALM TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4504
Mailing Address - Country:US
Mailing Address - Phone:626-354-2003
Mailing Address - Fax:
Practice Address - Street 1:140 E COLORADO BLVD STE D
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5145
Practice Address - Country:US
Practice Address - Phone:626-272-4908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health