Healthcare Provider Details

I. General information

NPI: 1902035397
Provider Name (Legal Business Name): AMANDA LUREE SMITH MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89733 ARMITAGE RD
EUGENE OR
97408-9243
US

IV. Provider business mailing address

609 BROOKSIDE DR
EUGENE OR
97405-2044
US

V. Phone/Fax

Practice location:
  • Phone: 541-579-7408
  • Fax:
Mailing address:
  • Phone: 541-579-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number08-12-72U
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC4167
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier164936
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: