Provider Demographics
NPI:1093593402
Name:BOURLAND, AMANDA K (LCADC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:BOURLAND
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 S PRESTON ST UNIT 17567
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-5022
Mailing Address - Country:US
Mailing Address - Phone:502-271-8268
Mailing Address - Fax:502-373-8086
Practice Address - Street 1:3705 BELLS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-2122
Practice Address - Country:US
Practice Address - Phone:502-271-8268
Practice Address - Fax:502-373-8086
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY288154101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health