Healthcare Provider Details

I. General information

NPI: 1053857466
Provider Name (Legal Business Name): AMANDA RENEE SANCHEZ MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RENEE FLORES

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19322 JESSE LN STE 200
RIVERSIDE CA
92508-5072
US

IV. Provider business mailing address

10103 54TH ST
RIVERSIDE CA
92509-3615
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number136377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: