Healthcare Provider Details

I. General information

NPI: 1326755166
Provider Name (Legal Business Name): AMANDA PALOMA LOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LOUISE GOLDEN

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 PEARL ST
EUGENE OR
97401-3541
US

IV. Provider business mailing address

698 CATTERLIN ST NE
SALEM OR
97301-2743
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-4340
  • Fax: 541-743-4369
Mailing address:
  • Phone: 971-218-4514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61510763
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: