Basic Information
| Provider Information | |||||||||
| NPI: | 1013506658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHMIDT | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW, LCSW, LNHA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3251 NETTIE ST | ||||||||
| Address2: | |||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597016531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067233225 | ||||||||
| FaxNumber: | 4067233225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3251 NETTIE ST | ||||||||
| Address2: | |||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597016531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067233225 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2021 | ||||||||
| LastUpdateDate: | 01/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | BBH-LCSW-LIC-42795 | MT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.