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General NPI Number Information
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NPI Number | 1386703106
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Entity Type | Individual
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Provider Name | THOMAS JOHN AMAYA SR. LCPC, LAC
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Gender | Male
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 9405 S AVENIDA DEL YAQUI
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City | GUADALUPE
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State | AZ
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Zip | 85283-2529
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Country | US
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Telephone | 480-768-2000
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Fax | 480-768-2053
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Provider Business Mailing Address
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Address Line | 4505 S HARDY DR APT 2121
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City | TEMPE
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State | AZ
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Zip | 85282-6569
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Country | US
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Telephone | 406-239-8749
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Fax | 480-768-2053
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 778
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1101
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License Number State | MT
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