Healthcare Provider Details

I. General information

NPI: 1801564679
Provider Name (Legal Business Name): AMANDA CHEYENNE M WESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2021
Last Update Date: 09/05/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8767 CARMEL VALLEY RD
CARMEL CA
93923-7958
US

IV. Provider business mailing address

225 MONROE ST APT 6
MONTEREY CA
93940-2200
US

V. Phone/Fax

Practice location:
  • Phone: 831-582-1017
  • Fax:
Mailing address:
  • Phone: 831-402-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC7410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: