Provider Demographics
NPI:1770310591
Name:BARNETT, AMANDA K (PCA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:BARNETT
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:K
Other - Last Name:CHARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17330 SW LAWTON ST APT 304
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-7625
Mailing Address - Country:US
Mailing Address - Phone:734-904-6635
Mailing Address - Fax:
Practice Address - Street 1:8285 SW NIMBUS AVE STE 148
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6465
Practice Address - Country:US
Practice Address - Phone:503-352-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health