MEDICARE: MISS AMANDA MARIE MATHEWS LPC

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1548845936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA MARIE MATHEWS LPC

Provider Business Mailing Address
First Line	:	3707 E SOUTHERN AVE STE 2022
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6214
Country	:	US
Telephone Number	:	623-522-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 E SOUTHERN AVE STE 2022
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6214
Country	:	US
Telephone Number	:	623-522-7005
Fax Number	:

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

Provider Enumeration Date	:	03/17/2021
Last Update Date	:	12/19/2024

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