Healthcare Provider Details

I. General information

NPI: 1780978304
Provider Name (Legal Business Name): LANCE MICHAEL AMOLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 DELAWARE ST
LONGVIEW WA
98632-2367
US

IV. Provider business mailing address

5757 N DIXIE HWY
OAKLAND PARK FL
33334-4135
US

V. Phone/Fax

Practice location:
  • Phone: 360-636-4836
  • Fax: 360-636-6792
Mailing address:
  • Phone: 954-734-2000
  • Fax: 954-734-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME120892
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME120892
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD70062150
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: