Provider Demographics
NPI:1558965285
Name:BURD, AMANDA KAY (LPCC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAY
Last Name:BURD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0625
Mailing Address - Country:US
Mailing Address - Phone:702-746-4357
Mailing Address - Fax:270-213-7026
Practice Address - Street 1:401 S GREEN ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-2555
Practice Address - Country:US
Practice Address - Phone:770-746-4357
Practice Address - Fax:270-213-7026
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267079101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100671150Medicaid