Provider Demographics
NPI:1821589383
Name:RASMUSSEN, AMANDA MAESER (LMFT REG INTERN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:MAESER
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:LMFT REG INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 LINN LN
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2911
Mailing Address - Country:US
Mailing Address - Phone:503-657-9697
Mailing Address - Fax:
Practice Address - Street 1:7000 SW HAMPTON ST STE 120
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8361
Practice Address - Country:US
Practice Address - Phone:971-800-1506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health