Provider Demographics
NPI:1184928996
Name:CENCAK, AMANDA J (LCMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:CENCAK
Suffix:
Gender:F
Credentials:LCMHC
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 681717
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-1717
Mailing Address - Country:US
Mailing Address - Phone:928-699-8645
Mailing Address - Fax:
Practice Address - Street 1:1500 KEARNS BLVD STE AG20
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7330
Practice Address - Country:US
Practice Address - Phone:435-565-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8675376-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health