Provider Demographics
NPI:1821366725
Name:STOREY, AMANDA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:STOREY
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:2084 46TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-1719
Mailing Address - Country:US
Mailing Address - Phone:505-310-5316
Mailing Address - Fax:
Practice Address - Street 1:1505 15TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3000
Practice Address - Country:US
Practice Address - Phone:505-662-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0144921101YM0800X
NM0176431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health