Amanda Renee Hart, CC, LMT

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CL61519127 Issued in WA

Practice address

1105 15TH Ave Ste F
Longview, WA 98632-3080

Phone

(360) 703-6499

Fax

(360) 838-9902

NPI assigned

May 9, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Amanda Renee Docksteader Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Haven Mind Body Collective, LLC

  • Mental Health Counselor
  • Longview, WA
  • NPI 1184477507
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1164699013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 15TH AVE STE F",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323080",
            "telephone_number": "360-703-6499",
            "fax_number": "360-838-9902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 15TH AVE STE F",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323080",
            "telephone_number": "360-703-6499",
            "fax_number": "360-838-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HART",
        "first_name": "AMANDA",
        "middle_name": "RENEE",
        "credential": "CC, LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00023855",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "CL61519127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "DOCKSTEADER",
            "middle_name": "RENEE",
            "credential": "LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shana Marie Harrington, R.N.
• Amie M Harris, AAC, CPC
• Kaydee Mae Harris, RDN
• Jenna Lee Harrison, LPN
• Julia E Harrison, LICSWA
• Nicole Elaine Harvill, RN
• Laura Mae Hathaway
• Susan E Hather, CDPT
• Mark Thomas Hattenhauer, MD
• Haven Mind Body Collective, LLC

• Mental Health Counselor in Longview, WA
• Providers in Longview, WA by specialty
• Mental Health Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.