Provider Demographics
NPI:1194091512
Name:LY, AMANDA DAHIR (BCBA-D, LMHC, PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DAHIR
Last Name:LY
Suffix:
Gender:F
Credentials:BCBA-D, LMHC, PHD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MAE
Other - Last Name:DAHIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2018 156TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3825
Mailing Address - Country:US
Mailing Address - Phone:802-589-0111
Mailing Address - Fax:206-926-1685
Practice Address - Street 1:2018 156TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3825
Practice Address - Country:US
Practice Address - Phone:802-589-0111
Practice Address - Fax:206-946-1685
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-09-5346103K00000X
WALH60331438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst