Healthcare Provider Details

I. General information

NPI: 1891268561
Provider Name (Legal Business Name): AMANDA MARIE LEICHTENTRITT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 N 99TH AVE STE 1-A
PEORIA AZ
85345-5466
US

IV. Provider business mailing address

3908 N 294TH LN
BUCKEYE AZ
85396-7125
US

V. Phone/Fax

Practice location:
  • Phone: 623-977-8373
  • Fax:
Mailing address:
  • Phone: 480-205-2671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-17627
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: