Healthcare Provider Details

I. General information

NPI: 1396111340
Provider Name (Legal Business Name): AMANDA KRISTINA LAWRENCE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SANTA BARBARA ST
SANTA BARBARA CA
93101-2232
US

IV. Provider business mailing address

720 SANTA BARBARA ST
SANTA BARBARA CA
93101-2232
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-4338
  • Fax:
Mailing address:
  • Phone: 805-963-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY33439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: