Healthcare Provider Details

I. General information

NPI: 1114529534
Provider Name (Legal Business Name): AMANDA ELIZABETH SEXTON CMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SABLE OAKS DR STE 230
SOUTH PORTLAND ME
04106-6954
US

IV. Provider business mailing address

PO BOX 330
MAGNA UT
84044-0330
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0005
  • Fax:
Mailing address:
  • Phone: 801-990-4300
  • Fax: 801-967-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12497799-6004
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC7220
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: