Provider Demographics
NPI:1760848808
Name:NEEBLE, AMANDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:NEEBLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23456 MADERO
Mailing Address - Street 2:210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2701
Mailing Address - Country:US
Mailing Address - Phone:949-439-9714
Mailing Address - Fax:
Practice Address - Street 1:23456 MADERO
Practice Address - Street 2:210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2701
Practice Address - Country:US
Practice Address - Phone:949-439-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist