Provider Demographics
NPI:1013265644
Name:PAINTER, AMANDA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:PAINTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:TAKACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2180 S 1450 W
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-6733
Mailing Address - Country:US
Mailing Address - Phone:801-695-5520
Mailing Address - Fax:
Practice Address - Street 1:2180 S 1450 W
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84339-6733
Practice Address - Country:US
Practice Address - Phone:801-695-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8934266-3501101Y00000X, 101YA0400X, 101YM0800X, 104100000X, 171M00000X, 1041C0700X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion