Provider Demographics
NPI:1790328573
Name:WALKER, AMANDA M (MACMHC; LCPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:MACMHC; LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 2ND AVE N STE 200A
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3243
Mailing Address - Country:US
Mailing Address - Phone:406-868-0228
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 200A
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3243
Practice Address - Country:US
Practice Address - Phone:406-868-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-39032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional