Provider Demographics
NPI:1962703959
Name:DAVID, AMIRAH (MA, LPC, PMH-C)
Entity type:Individual
Prefix:
First Name:AMIRAH
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:MA, LPC, PMH-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E HERSEY ST # 6B
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-5200
Mailing Address - Country:US
Mailing Address - Phone:541-708-3566
Mailing Address - Fax:
Practice Address - Street 1:300 E HERSEY ST # 6B
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-5200
Practice Address - Country:US
Practice Address - Phone:541-708-3566
Practice Address - Fax:606-240-1934
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional