Healthcare Provider Details

I. General information

NPI: 1861633729
Provider Name (Legal Business Name): AMANDA O'NEIL MACKINNON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SMELTER AVE NE
GREAT FALLS MT
59404-1927
US

IV. Provider business mailing address

511 CENTRAL AVE W
GREAT FALLS MT
59404-2848
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-7130
  • Fax:
Mailing address:
  • Phone: 406-247-7130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5584
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: