Healthcare Provider Details

I. General information

NPI: 1487045258
Provider Name (Legal Business Name): AMANDA NICOLE TRANCOSO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E CLARK AVE STE A2
SANTA MARIA CA
93455-5192
US

IV. Provider business mailing address

400 W PARK AVE
SANTA MARIA CA
93458-6116
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-1512
  • Fax: 805-739-2855
Mailing address:
  • Phone: 805-736-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160968
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number8239
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: