Provider Demographics
NPI:1023335429
Name:MAZOUCH, AMANDA J (LCMFT)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:MAZOUCH
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:J
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMFT
Mailing Address - Street 1:322 HOUSTON ST STE 106
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-6497
Mailing Address - Country:US
Mailing Address - Phone:785-477-0231
Mailing Address - Fax:
Practice Address - Street 1:322 HOUSTON ST STE 106
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-6497
Practice Address - Country:US
Practice Address - Phone:785-477-0231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS882106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist