Healthcare Provider Details

I. General information

NPI: 1467204388
Provider Name (Legal Business Name): AMANDA EFFERTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34931 US HIGHWAY 19 N STE 107
PALM HARBOR FL
34684-1901
US

IV. Provider business mailing address

4151 NEWBURY DR
NEW PORT RICHEY FL
34652-5757
US

V. Phone/Fax

Practice location:
  • Phone: 786-423-6787
  • Fax:
Mailing address:
  • Phone: 651-216-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: