Provider Demographics
NPI:1184031817
Name:ORTT, AMANDA GRACE (MED, LPCC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:GRACE
Last Name:ORTT
Suffix:
Gender:F
Credentials:MED, LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10867 HOPKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6859
Mailing Address - Country:US
Mailing Address - Phone:270-963-0045
Mailing Address - Fax:270-667-9065
Practice Address - Street 1:111 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-2249
Practice Address - Country:US
Practice Address - Phone:270-601-6725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional