Individual
AMANDA JAY PETRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1180 N TOWN CENTER DR STE 100, LAS VEGAS, NV 89144-6308
(775) 657-1688
Mailing address
1180 N TOWN CENTER DR STE 100, LAS VEGAS, NV 89144-6308
(775) 657-1688
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8638-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100557642
—
NV
Enumeration date
02/16/2018
Last updated
07/29/2022
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