Individual
THOMAS JOHN AMAYA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC, LAC
Contact information
Practice address
9405 S AVENIDA DEL YAQUI, GUADALUPE, AZ 85283-2529
(480) 768-2000
(480) 768-2053
Mailing address
4505 S HARDY DR APT 2121, TEMPE, AZ 85282-6569
(406) 239-8749
(480) 768-2053
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
778
MT
101YA0400X
Addiction (Substance Use Disorder) Counselor
1101
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0256989
—
MT
01
—
1101
LICENSE FOR LAC
MT
01
—
778
LICENSE FOR LCPC
MT
Enumeration date
12/07/2006
Last updated
02/11/2008
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