Amanda Sullivan-Kersey, M.DIV., PSYD

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

335 3Rd St
Raymond, WA 98577-2413

Phone

(360) 261-6930

NPI assigned

Apr 4, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Community Integrated Health Services, LLC

  • Community/Behavioral Health Agency
  • Centralia, WA
  • NPI 1942840160

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1680566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1649975889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "335 3RD ST",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985772413",
            "telephone_number": "360-261-6930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 3RD ST",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985772413",
            "telephone_number": "360-261-6930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN-KERSEY",
        "first_name": "AMANDA",
        "name_prefix": "Dr.",
        "credential": "M.DIV., PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Staats, SUDPT
• Hayden David-James Stidham
• Heidi Stonebraker, SLP
• Jake Mitchell Strozzi
• Taylor Strozzi
• Sun and Moon Inc.
• Tobi N Thaller, MD
• Bryan Randall Tienhaara
• Tera Triplett Stroup
• Alivia Joelle Tyler

• Mental Health Counselor in Raymond, WA
• Providers in Raymond, 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 Apr 4, 2023; 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.