Provider Demographics
NPI:1568965408
Name:TORTORIGE, AMANDA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:TORTORIGE
Suffix:
Gender:F
Credentials:LPC
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 621
Mailing Address - Street 2:
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588-0621
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:
Practice Address - Street 1:MILE 111.5 RICHARDSON HIGHWAY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-9957
Practice Address - Country:US
Practice Address - Phone:907-822-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
AK149375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health