Provider Demographics
NPI:1780322479
Name:AMANDA SUNSHINE COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:AMANDA SUNSHINE COUNSELING SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-664-7540
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:OK
Mailing Address - Zip Code:73737
Mailing Address - Country:US
Mailing Address - Phone:405-664-7540
Mailing Address - Fax:580-701-2658
Practice Address - Street 1:1425 N MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:FAIRVIEW
Practice Address - State:OK
Practice Address - Zip Code:73737
Practice Address - Country:US
Practice Address - Phone:405-664-7540
Practice Address - Fax:580-701-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty