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THOMAS JOHN AMAYA LCPC, LAC

>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1386703106

Individual Registrant:
 THOMAS JOHN AMAYA LCPC, LAC
Gender: M
Sole Proprietor

Location and contact information for practice:
9405 S AVENIDA DEL YAQUI  GUADALUPE, AZ 85283-2529 US
Tel: 480-768-2000  Fax: 480-768-2053

Contact information for business:
4505 S HARDY DR APT 2121  TEMPE, AZ 85282-6569 US
Tel: 406-239-8749  Fax: 480-768-2053

Registration Information:
NPI: 1386703106
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101Y00000XBehavioral Health & Social Service Providers
Counselor
MT778
N101YA0400XBehavioral Health & Social Service Providers
Counselor
MT1101

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
LICENSE FOR LAC1101MT01
0256989MT05
LICENSE FOR LCPC778MT01




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