Provider Demographics
NPI:1326755166
Name:LOVE, AMANDA PALOMA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:PALOMA
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LOUISE
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:698 CATTERLIN ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2743
Mailing Address - Country:US
Mailing Address - Phone:971-218-4514
Mailing Address - Fax:
Practice Address - Street 1:1170 PEARL ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3541
Practice Address - Country:US
Practice Address - Phone:541-743-4340
Practice Address - Fax:541-743-4369
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61510763101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health