MEDICARE: AMANDA LEIGH OWENSBY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACD.0001347	CO
2	101YM0800X	Mental Health Counselor	A5812	OR
3	101YM0800X	Mental Health Counselor	SC61106588	WA
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	19R27	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08-2019	OTHER	CA	MSW

General Provider Information

NPI Number	:	1053894675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEIGH OWENSBY LICSW

Provider Business Mailing Address
First Line	:	6929 NW FRIBERG STRUNK ST STE 270
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7070
Country	:	US
Telephone Number	:	360-627-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	6929 NW FRIBERG STRUNK ST STE 270
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-7070
Country	:	US
Telephone Number	:	360-627-1359
Fax Number	:	360-282-1022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	05/07/2025

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