Provider Demographics
NPI:1043764764
Name:UNGS, AMANDA (MA, LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:UNGS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 2ND ST W
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1409
Mailing Address - Country:US
Mailing Address - Phone:651-235-5403
Mailing Address - Fax:
Practice Address - Street 1:105 2ND ST W
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MN
Practice Address - Zip Code:55352-1409
Practice Address - Country:US
Practice Address - Phone:651-235-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional