Healthcare Provider Details

I. General information

NPI: 1669084844
Provider Name (Legal Business Name): AMANDA MARKS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 KIMBALL AVE STE 153
WATERLOO IA
50702-5759
US

IV. Provider business mailing address

3336 KIMBALL AVE STE 153
WATERLOO IA
50702-5759
US

V. Phone/Fax

Practice location:
  • Phone: 319-595-4646
  • Fax:
Mailing address:
  • Phone: 319-595-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number096544
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: