Healthcare Provider Details

I. General information

NPI: 1568279594
Provider Name (Legal Business Name): AMANDA OLNEY LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA ROBERSON MED COUNSELING

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 19TH AVE SW
PUYALLUP WA
98371-7465
US

IV. Provider business mailing address

521 19TH AVE SW
PUYALLUP WA
98371-7465
US

V. Phone/Fax

Practice location:
  • Phone: 360-830-6684
  • Fax:
Mailing address:
  • Phone: 206-819-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61575672
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: