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General NPI Number Information
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NPI Number | 1629560875
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Entity Type | Individual
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Provider Name | AMANDA JO BOE
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Gender | Female
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 421 W PLUMB LN STE 1
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City | RENO
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State | NV
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Zip | 89509-3766
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Country | US
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Telephone | 775-525-0091
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Fax |
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Provider Business Mailing Address
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Address Line | 3115 DANVILLE DR
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City | SPARKS
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State | NV
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Zip | 89434-1722
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Country | US
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Telephone | 775-200-5708
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NV
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