Provider Demographics
NPI:1396575072
Name:YOUNGBLOOD, AMANDA JEAN (LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 ELLISON RD NW STE B1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-7015
Mailing Address - Country:US
Mailing Address - Phone:505-220-3734
Mailing Address - Fax:
Practice Address - Street 1:4101 MONTERA PL NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5544
Practice Address - Country:US
Practice Address - Phone:505-220-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0419101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health