Provider Demographics
NPI:1427838812
Name:IZEN, AMANDA STEPHANIE (AMFT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:STEPHANIE
Last Name:IZEN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16867 KINGSBURY ST APT 106
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6443
Mailing Address - Country:US
Mailing Address - Phone:818-648-6472
Mailing Address - Fax:
Practice Address - Street 1:16867 KINGSBURY ST APT 106
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6443
Practice Address - Country:US
Practice Address - Phone:818-648-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health