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General NPI Number Information
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NPI Number | 1497491559
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Entity Type | Organization
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Legal Business Name | AMANDA WISSLER COUNSELING, PLLC
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 2078 PROSPECTOR AVE STE 1
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City | PARK CITY
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State | UT
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Zip | 84060-7587
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Country | US
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Telephone | 801-448-8264
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Fax |
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Provider Business Mailing Address
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Address Line | 6749 N 2200 W APT B103
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City | PARK CITY
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State | UT
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Zip | 84098-8305
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Country | US
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Telephone | 801-448-8264
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | AMANDA WISSLER
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Credential | LCSW
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Telephone | 801-448-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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