Healthcare Provider Details

I. General information

NPI: 1366318917
Provider Name (Legal Business Name): AMANDA AKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S 11TH ST
PHILOMATH OR
97370-9083
US

IV. Provider business mailing address

99 W F ST APT 26
CRESWELL OR
97426-9582
US

V. Phone/Fax

Practice location:
  • Phone: 541-234-3271
  • Fax:
Mailing address:
  • Phone: 541-971-3058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: