Provider Demographics
NPI:1053680199
Name:KEENER, AMANDA MICHELLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MICHELLE
Last Name:KEENER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 DAYTONA DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-7534
Mailing Address - Country:US
Mailing Address - Phone:865-964-9024
Mailing Address - Fax:
Practice Address - Street 1:100 5TH ST STE 310
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-5919
Practice Address - Country:US
Practice Address - Phone:833-928-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional