Provider Demographics
NPI:1366038671
Name:ANDERSON, AMANDA LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:570 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3530
Mailing Address - Country:US
Mailing Address - Phone:724-504-2767
Mailing Address - Fax:
Practice Address - Street 1:570 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3530
Practice Address - Country:US
Practice Address - Phone:724-504-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACP012920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional