Provider Demographics
NPI:1366979791
Name:COLLOPY, AMANDA MARIE (MHP, MSW)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MARIE
Last Name:COLLOPY
Suffix:
Gender:F
Credentials:MHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 STUART ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3751
Mailing Address - Country:US
Mailing Address - Phone:509-540-5796
Mailing Address - Fax:
Practice Address - Street 1:455 W ROSE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1792
Practice Address - Country:US
Practice Address - Phone:509-524-2803
Practice Address - Fax:509-524-2836
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health