Provider Demographics
NPI:1053894675
Name:OWENSBY, AMANDA LEIGH (CADC III)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEIGH
Last Name:OWENSBY
Suffix:
Gender:F
Credentials:CADC III
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEIGH
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSWAIC
Mailing Address - Street 1:18309 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-9803
Mailing Address - Country:US
Mailing Address - Phone:970-379-1193
Mailing Address - Fax:
Practice Address - Street 1:534 NE EVERETT ST STE 200302
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2043
Practice Address - Country:US
Practice Address - Phone:360-930-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19R27101YA0400X
COACD.0001347101YA0400X
ORA5812101YM0800X
WASC61106588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA08-2019OtherMSW