Provider Demographics
NPI:1578682688
Name:AMANAMBU, AUSTIN (LPC)
Entity type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:AMANAMBU
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 SE HALE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2586
Mailing Address - Country:US
Mailing Address - Phone:915-204-5463
Mailing Address - Fax:
Practice Address - Street 1:6747 SE HALE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2586
Practice Address - Country:US
Practice Address - Phone:915-204-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7304101YM0800X
TX77965101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional