Provider Demographics
NPI:1336925155
Name:PRINCE, AMANDA L (LMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:PRINCE
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 1:250 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4608
Mailing Address - Country:US
Mailing Address - Phone:310-867-3072
Mailing Address - Fax:
Practice Address - Street 1:250 CANYON RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4608
Practice Address - Country:US
Practice Address - Phone:310-867-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist