Provider Demographics
NPI:1104259811
Name:ROE, AMANDA NOELLE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:NOELLE
Last Name:ROE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 1/2 W 9TH AVE
Mailing Address - Street 2:432
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2853
Mailing Address - Country:US
Mailing Address - Phone:620-719-8229
Mailing Address - Fax:620-229-8124
Practice Address - Street 1:104 1/2 W 9TH AVE
Practice Address - Street 2:432
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2853
Practice Address - Country:US
Practice Address - Phone:620-719-8229
Practice Address - Fax:620-229-8124
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist