Provider Demographics
NPI:1407354632
Name:MCKINNEY, AMANDA LYN (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LYN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 WIN HENTSCHEL BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4149
Mailing Address - Country:US
Mailing Address - Phone:765-444-3999
Mailing Address - Fax:
Practice Address - Street 1:1330 WIN HENTSCHEL BLVD STE 202
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-4149
Practice Address - Country:US
Practice Address - Phone:765-444-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043000A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical