Provider Demographics
NPI:1376396598
Name:AMAYA, HEATHER (LMSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:AMAYA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6114 W CENTRAL AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2885
Mailing Address - Country:US
Mailing Address - Phone:316-205-9396
Mailing Address - Fax:
Practice Address - Street 1:6114 W CENTRAL AVE STE 104
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2885
Practice Address - Country:US
Practice Address - Phone:316-205-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10922104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker