Healthcare Provider Details

I. General information

NPI: 1548800287
Provider Name (Legal Business Name): AMANDA MARIE VOGEL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 BOONE AVE N
NEW HOPE MN
55428-3636
US

IV. Provider business mailing address

5555 BOONE AVE N
NEW HOPE MN
55428-3636
US

V. Phone/Fax

Practice location:
  • Phone: 763-515-2462
  • Fax: 763-331-3039
Mailing address:
  • Phone: 763-515-2462
  • Fax: 763-331-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2352
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: