Healthcare Provider Details

I. General information

NPI: 1922740596
Provider Name (Legal Business Name): AMY MANION LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 SW CROWELL WAY STE 100
BEND OR
97702-1178
US

IV. Provider business mailing address

62227 POWELL BUTTE HWY
BEND OR
97701-9355
US

V. Phone/Fax

Practice location:
  • Phone: 541-604-8733
  • Fax: 877-640-1415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT3091
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: