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General NPI Number Information
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NPI Number | 1780322479
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Entity Type | Organization
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Legal Business Name | AMANDA SUNSHINE COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 1425 N MAIN ST STE 2
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City | FAIRVIEW
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State | OK
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Zip | 73737
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Country | US
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Telephone | 405-664-7540
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Fax | 580-701-2658
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | FAIRVIEW
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State | OK
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Zip | 73737
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Country | US
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Telephone | 405-664-7540
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Fax | 580-701-2658
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA WIENS
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Credential | LPC
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Telephone | 405-664-7540
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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 |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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