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NPI Code Detail

MEDICARE: DR. AMANDA BETH ELDER PSYD

MEDICARE: DR. AMANDA BETH ELDER PSYD
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
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program
3103TC0700XClinical PsychologistPSY31928CA

General Provider Information

NPI Number : 1114174877
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA BETH ELDER PSYD
Provider Business Mailing Address
First Line : 1430 WILLOW PASS RD STE 100
Second Line :
City : CONCORD
State : CA
Zip : 94520-7946
Country : US
Telephone Number : 925-288-3907
Fax Number : 925-646-5774
Provider Business Practice Location Address
First Line : 1430 WILLOW PASS RD STE 100
Second Line :
City : CONCORD
State : CA
Zip : 94520-7946
Country : US
Telephone Number : 925-288-3907
Fax Number : 925-646-5774
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2008
Last Update Date : 04/08/2021

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