Provider Demographics
NPI:1205069747
Name:SOMMERFELD, AMANDA M (LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:SOMMERFELD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:HAASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5910 N 15TH ST APT B101
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2400
Mailing Address - Country:US
Mailing Address - Phone:253-232-8072
Mailing Address - Fax:
Practice Address - Street 1:104 W MEEKER STE E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8901
Practice Address - Country:US
Practice Address - Phone:253-232-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60561520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health