Provider Demographics
NPI:1982468336
Name:SHIPTON, AMANDA RAE (MS, PPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:SHIPTON
Suffix:
Gender:F
Credentials:MS, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1808
Mailing Address - Country:US
Mailing Address - Phone:307-232-0159
Mailing Address - Fax:
Practice Address - Street 1:350 N ASH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1808
Practice Address - Country:US
Practice Address - Phone:307-232-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1431101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty