Healthcare Provider Details

I. General information

NPI: 1114287463
Provider Name (Legal Business Name): AMANDA THERESA PANTALEON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 OLD RIVER RD
UKIAH CA
95482-6103
US

IV. Provider business mailing address

2240 OLD RIVER RD
UKIAH CA
95482-6103
US

V. Phone/Fax

Practice location:
  • Phone: 707-467-5145
  • Fax:
Mailing address:
  • Phone: 707-467-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberMFC93604
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC93604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: