Provider Demographics
NPI:1861828626
Name:SANCHEZ, AMANDA (CADC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 LOMAX ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6264
Mailing Address - Country:US
Mailing Address - Phone:208-522-6925
Mailing Address - Fax:208-522-6934
Practice Address - Street 1:522 LOMAX ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6264
Practice Address - Country:US
Practice Address - Phone:208-522-6925
Practice Address - Fax:208-522-6934
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11638101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)