Provider Demographics
NPI:1578228235
Name:KEFFNER, AMANDA BROOKE (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:BROOKE
Last Name:KEFFNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:KEFFNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5600 N FLAGLER DR APT 402
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2647
Mailing Address - Country:US
Mailing Address - Phone:732-779-3888
Mailing Address - Fax:
Practice Address - Street 1:7100 CAMINO REAL STE 404
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-571-1557
Practice Address - Fax:561-634-3537
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18870101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health