Provider Demographics
NPI:1386777886
Name:MERTEL, AMANDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:MERTEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 E MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3901
Mailing Address - Country:US
Mailing Address - Phone:602-237-6653
Mailing Address - Fax:602-957-3600
Practice Address - Street 1:3202 E MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3901
Practice Address - Country:US
Practice Address - Phone:602-237-6653
Practice Address - Fax:602-957-3600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22900103TC0700X
AZ4160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical