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General NPI Number Information
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NPI Number | 1164699013
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Entity Type | Individual
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Provider Name | AMANDA RENEE HART CC, LMT
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Gender | Female
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 1105 15TH AVE STE F
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City | LONGVIEW
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State | WA
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Zip | 98632-3080
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Country | US
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Telephone | 360-703-6499
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Fax | 360-838-9902
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Provider Business Mailing Address
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Address Line | 1105 15TH AVE STE F
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City | LONGVIEW
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State | WA
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Zip | 98632-3080
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Country | US
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Telephone | 360-703-6499
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Fax | 360-838-9902
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00023855
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CL61519127
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License Number State | WA
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