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General NPI Number Information
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NPI Number | 1962925784
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Entity Type | Individual
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Provider Name | AMANDA SHAREE SPENCER
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Gender | Female
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Dates
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Enumeration Date | 07/24/2017
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 932 W STATE HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-2301
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Country | US
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Telephone | 405-577-5477
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Fax |
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Provider Business Mailing Address
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Address Line | 932 W STATE HIGHWAY 152
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City | MUSTANG
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State | OK
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Zip | 73064-2301
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Country | US
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Telephone | 757-672-9354
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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 |
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