Healthcare Provider Details

I. General information

NPI: 1194602060
Provider Name (Legal Business Name): AMANDA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA GREENE MA, PPS

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 AIRPORT BLVD
RED BLUFF CA
96080-4514
US

IV. Provider business mailing address

2455 BEVERLY DR
REDDING CA
96002-0915
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-7200
  • Fax:
Mailing address:
  • Phone: 530-356-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: