Provider Demographics
NPI:1821380411
Name:CAMACHO, AMANDA LYN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYN
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 SHARLANDS AVE UNIT AD1180
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2769
Mailing Address - Country:US
Mailing Address - Phone:775-560-5405
Mailing Address - Fax:
Practice Address - Street 1:1101 W MOANA LN
Practice Address - Street 2:SUITE 2
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4775
Practice Address - Country:US
Practice Address - Phone:775-337-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health