Provider Demographics
NPI:1962800789
Name:BERNAL, AMANDA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:MAE
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 CENTERPOINTE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8696
Mailing Address - Country:US
Mailing Address - Phone:971-400-7787
Mailing Address - Fax:971-209-7260
Practice Address - Street 1:5 CENTERPOINTE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8696
Practice Address - Country:US
Practice Address - Phone:971-400-7787
Practice Address - Fax:971-209-7260
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist