Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 17309 | AZ |
N | 101YP2500X | Professional Counselor | 2537 | KS |
NPI | 1003331695 |
---|---|
Provider Name | Amanda Mccarron |
First Address | Phoenix, AZ 85012-2929 |
Second Address | Glendale, AZ 85302-4598 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 03/11/2020 |