Provider Demographics
NPI:1982214912
Name:HENDRICKS, AMANDA ANN (LPCC,ATR-BC,MFA,RYT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LPCC,ATR-BC,MFA,RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-0728
Mailing Address - Country:US
Mailing Address - Phone:888-707-3267
Mailing Address - Fax:
Practice Address - Street 1:20 S SANTA CRUZ AVE STE 300
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6827
Practice Address - Country:US
Practice Address - Phone:888-707-3267
Practice Address - Fax:669-356-1460
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7898101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty