Provider Demographics
NPI:1285993857
Name:GAUTREAUX, AMANDA (LCMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GAUTREAUX
Suffix:
Gender:
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:ME
Mailing Address - Zip Code:04987-3201
Mailing Address - Country:US
Mailing Address - Phone:802-365-1751
Mailing Address - Fax:
Practice Address - Street 1:11 WARD HILL RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:ME
Practice Address - Zip Code:04987-3201
Practice Address - Country:US
Practice Address - Phone:802-365-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135938101YM0800X
MECC7670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263824Medicaid