Provider Demographics
NPI:1972866507
Name:HOLMBERG, AMANDA JOY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JOY
Last Name:HOLMBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PLYMOUTH BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-1393
Mailing Address - Country:US
Mailing Address - Phone:651-401-5010
Mailing Address - Fax:
Practice Address - Street 1:3535 PLYMOUTH BLVD # 3535
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-1385
Practice Address - Country:US
Practice Address - Phone:651-401-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist