Provider Demographics
NPI:1346874617
Name:AMANDA LAMP, MSW
Entity Type:Organization
Organization Name:AMANDA LAMP, MSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:229-460-8186
Mailing Address - Street 1:3030 S INVERNESS FARM RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9110
Mailing Address - Country:US
Mailing Address - Phone:229-460-8186
Mailing Address - Fax:
Practice Address - Street 1:3030 S INVERNESS FARM RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9110
Practice Address - Country:US
Practice Address - Phone:229-460-8186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty