Provider Demographics
NPI:1972870426
Name:GARZA, AMANDA RAE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RAE
Last Name:GARZA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:615 N LARKSPUR LN
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-1892
Mailing Address - Country:US
Mailing Address - Phone:509-331-6436
Mailing Address - Fax:
Practice Address - Street 1:10505 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-8613
Practice Address - Country:US
Practice Address - Phone:509-378-5553
Practice Address - Fax:509-579-4088
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60695947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health