Provider Demographics
NPI:1861633729
Name:MACKINNON, AMANDA O'NEIL (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:O'NEIL
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-2848
Mailing Address - Country:US
Mailing Address - Phone:406-247-7130
Mailing Address - Fax:
Practice Address - Street 1:425 SMELTER AVE NE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-1927
Practice Address - Country:US
Practice Address - Phone:406-247-7130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22582103TC0700X
MT5584103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical