# AMANDA WISIAN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1306190202
- **Gender:** F
- **Credential:** LPC, PMHNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | 0011133 | CO | — |
| 101YP2500X | Professional Counselor | 7142009-6004 | UT | — |
| 101YP2500X | Professional Counselor | LH 60290236 | WA | — |
| 2084P0800X | Psychiatry Physician | 0011133 | CO | — |
| 2084P0800X | Psychiatry Physician | RN.1659896 | CO | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 0998730 | CO | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | 1659896 | CO | — |
| 390200000X | Student in an Organized Health Care Education/Training Program | RN.1659896 | CO | — |

## Other

- **Enumeration date:** 10/31/2012
- **Last updated:** 01/03/2024