MEDICARE: MS. AMANDA MICHELLE MAYOH MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	RC00059027	WA

General Provider Information

NPI Number	:	1578724498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA MICHELLE MAYOH MA

Provider Business Mailing Address
First Line	:	15 S GRADY WAY STE 249
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3209
Country	:	US
Telephone Number	:	253-220-9453
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 S GRADY WAY STE 249
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-3209
Country	:	US
Telephone Number	:	253-220-9453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	04/28/2019

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