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General NPI Number Information
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NPI Number | 1861633729
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Entity Type | Individual
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Provider Name | AMANDA O'NEIL MACKINNON PSYD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 425 SMELTER AVE NE
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City | GREAT FALLS
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State | MT
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Zip | 59404-1927
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Country | US
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Telephone | 406-247-7130
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Fax |
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Provider Business Mailing Address
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Address Line | 511 CENTRAL AVE W
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City | GREAT FALLS
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State | MT
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Zip | 59404-2848
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Country | US
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Telephone | 406-247-7130
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22582
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5584
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License Number State | MT
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