Provider Demographics
NPI:1366079014
Name:SCHMIDT, AMANDA (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:STEBOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC, LADC
Mailing Address - Street 1:1875 STATION PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3319
Mailing Address - Country:US
Mailing Address - Phone:763-482-9598
Mailing Address - Fax:
Practice Address - Street 1:1875 STATION PKWY NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3319
Practice Address - Country:US
Practice Address - Phone:763-482-9598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305542101YA0400X
MN02044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)