Healthcare Provider Details

I. General information

NPI: 1275142366
Provider Name (Legal Business Name): AMANDA MENTZER BS MA MA MPHIL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3530 S VAL VISTA DR
GILBERT AZ
85297-7318
US

IV. Provider business mailing address

3150 E RAY RD APT 464
GILBERT AZ
85296-7500
US

V. Phone/Fax

Practice location:
  • Phone: 623-250-7287
  • Fax:
Mailing address:
  • Phone: 717-554-4053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5749
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: