Healthcare Provider Details

I. General information

NPI: 1821366725
Provider Name (Legal Business Name): AMANDA STOREY MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA SCHNEIDER MA, LMHC

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 15TH ST SUITE C
LOS ALAMOS NM
87544-3000
US

IV. Provider business mailing address

2084 46TH ST
LOS ALAMOS NM
87544-1719
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-3264
  • Fax:
Mailing address:
  • Phone: 505-310-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0144921
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0176431
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: