Provider Demographics
NPI:1669560637
Name:DAVISON, AMANDA S (LMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:S
Last Name:DAVISON
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 1:6001 WHITEMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2196
Mailing Address - Country:US
Mailing Address - Phone:505-717-1155
Mailing Address - Fax:505-717-1473
Practice Address - Street 1:6001 WHITEMAN DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2196
Practice Address - Country:US
Practice Address - Phone:505-717-1155
Practice Address - Fax:505-717-1473
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0087911106H00000X
NM0099731106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM202005549OtherPRESBYTERIAN HEALTH PLAN
NM46751386Medicaid