Provider Demographics
NPI:1780956136
Name:KING, AMANDA LYN (LMFT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:LYN
Last Name:KING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYN
Other - Last Name:ASHWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1305 TOMMYDON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3364
Mailing Address - Country:US
Mailing Address - Phone:209-476-5490
Mailing Address - Fax:209-476-3528
Practice Address - Street 1:1305 TOMMYDON ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3364
Practice Address - Country:US
Practice Address - Phone:209-476-5490
Practice Address - Fax:209-476-3528
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist