Provider Demographics
NPI:1861019176
Name:HEATH, AMANDA DAWN
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAWN
Last Name:HEATH
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 1:9293 SKYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9589
Mailing Address - Country:US
Mailing Address - Phone:406-350-1121
Mailing Address - Fax:
Practice Address - Street 1:141 DISCOVERY DR STE 115
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4134
Practice Address - Country:US
Practice Address - Phone:406-350-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT43128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health