Provider Demographics
NPI:1356961775
Name:AMANDA DONATH PSYCHOLOGICAL SERVICES S C
Entity type:Organization
Organization Name:AMANDA DONATH PSYCHOLOGICAL SERVICES S C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-226-2006
Mailing Address - Street 1:712 SUMMIT AVE STE 714
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3827
Mailing Address - Country:US
Mailing Address - Phone:262-262-2006
Mailing Address - Fax:262-226-2462
Practice Address - Street 1:712 SUMMIT AVE STE 714
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3827
Practice Address - Country:US
Practice Address - Phone:262-262-2006
Practice Address - Fax:262-226-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty