Provider Demographics
NPI:1437660479
Name:FETZNER, AMANDA D
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:D
Last Name:FETZNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDI
Other - Middle Name:
Other - Last Name:FETZNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANDI FETZNER LPC
Mailing Address - Street 1:2066 W CHOLLA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1087
Mailing Address - Country:US
Mailing Address - Phone:480-600-5113
Mailing Address - Fax:
Practice Address - Street 1:2066 W CHOLLA VISTA DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1087
Practice Address - Country:US
Practice Address - Phone:818-788-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23383101YP2500X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician