Healthcare Provider Details

I. General information

NPI: 1871007237
Provider Name (Legal Business Name): AMANDA HANCOCK MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 XERXES AVE S STE 225
BLOOMINGTON MN
55431-1253
US

IV. Provider business mailing address

7901 XERXES AVE S STE 225
BLOOMINGTON MN
55431-1253
US

V. Phone/Fax

Practice location:
  • Phone: 952-544-6806
  • Fax: 952-545-0098
Mailing address:
  • Phone: 952-544-6806
  • Fax: 952-545-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3521
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: