Provider Demographics
NPI:1790328573
Name:RASEY, AMANDA M (MACMHC; LCPC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:M
Last Name:RASEY
Suffix:
Gender:F
Credentials:MACMHC; LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:BLACK EAGLE
Mailing Address - State:MT
Mailing Address - Zip Code:59414-0274
Mailing Address - Country:US
Mailing Address - Phone:406-868-0228
Mailing Address - Fax:877-828-5889
Practice Address - Street 1:600 CENTRAL AVE STE 407
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3143
Practice Address - Country:US
Practice Address - Phone:406-868-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-39032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional