Provider Demographics
NPI:1265815351
Name:AMANDA PATTERSON, LMHC, LLC
Entity Type:Organization
Organization Name:AMANDA PATTERSON, LMHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-258-8845
Mailing Address - Street 1:5400 S UNIVERSITY DR STE 308
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5310
Mailing Address - Country:US
Mailing Address - Phone:954-378-3851
Mailing Address - Fax:
Practice Address - Street 1:5400 S UNIVERSITY DR STE 308
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5310
Practice Address - Country:US
Practice Address - Phone:543-785-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10243101YM0800X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty