AMANDA VISSERING LPCC, LMHC, PPSC
NPI 1972952042
Counselor - Professional in San Rafael, CA

Q: What is Amanda Vissering's NPI number?

The NPI number for Amanda Vissering is 1972952042. It was assigned to this individual provider in the NPPES registry on June 8, 2016. The provider is also known as Aj Vissering.

Q: What is Amanda Vissering's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Vissering was last updated on December 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 08, 2016PECOS EnrolledAccepts Medicare Assignment

30 PROFESSIONAL CENTER PKWY, SAN RAFAEL, CA 94903(206) 572-0805 Get Directions Write a Review

NPPES record last updated: December 21, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 21, 2024, Jun 3, 2024, May 2, 2024 and 2 more (5 updates tracked since 2017).

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About Amanda Vissering Lpcc, Lmhc, Ppsc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMANDA VISSERING LPCC, LMHC, PPSC (NPI 1972952042) is an individual professional provider in San Rafael, California, licensed in California (8679) and active in the NPI registry since June 2016. The provider is enrolled in Medicare PECOS, maintains a secondary practice location in Oakland, and is a graduate of Other (2016).

NPPES Registry Identity

NPI1972952042

Entity TypeIndividual

Primary Taxonomy101YP2500X

Provider Legal NameAMANDA VISSERINGCredential: LPCC, LMHC, PPSC

Location Address30 PROFESSIONAL CENTER PKWYSan Rafael, CA 94903-2757

Mailing Address8945 Golf Links RdOakland, CA 94605-4124 · (510) 654-4004

Phone(206) 572-0805

Sole ProprietorYes

Medical School CMSOtherGraduated 2016

Enumeration DateJune 8, 2016

Last NPPES UpdateDecember 21, 20245 updates tracked since enumeration

NPPES CertifiedDecember 21, 2024

✔ NPI 1972952042 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in CA · 8679

Also ListedCounselor · Mental HealthTaxonomy 101YM0800X · License LH61129627 (WA), 8679 (CA)

30 PROFESSIONAL CENTER PKWY, San Rafael, CA 94903

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Other Names 1

Other Name (5)Aj Vissering

Secondary Practice Location 1

Location 1445 Bellevue Ave Ste 6COakland, CA 94610-4923 · Phone (206) 317-4417

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Amanda Vissering Lpcc, Lmhc, Ppsc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9133695976

PECOS Enrollment IDI20260418000277

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SOFIA C DOWER-VASQUEZ

Day Training/Habilitation Specialist