Provider Demographics
NPI:1528333796
Name:TERRONEZ, AMANDA KAY (LMFT)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:KAY
Last Name:TERRONEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SHAW AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3819
Mailing Address - Country:US
Mailing Address - Phone:559-470-8331
Mailing Address - Fax:
Practice Address - Street 1:55 SHAW AVE STE 115
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-825-1324
Practice Address - Fax:559-408-5557
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52136101YM0800X, 101YS0200X, 261QM0801X, 261QM0850X, 261QR1300X, 261QM0855X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health