Provider Demographics
NPI:1740849389
Name:BANFILL, AMANDA K (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:K
Last Name:BANFILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 N MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6204
Mailing Address - Country:US
Mailing Address - Phone:844-416-4673
Mailing Address - Fax:
Practice Address - Street 1:3929 N 2700 W
Practice Address - Street 2:
Practice Address - City:FARR WEST
Practice Address - State:UT
Practice Address - Zip Code:84404-5095
Practice Address - Country:US
Practice Address - Phone:435-232-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8148339-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical