Provider Demographics
NPI:1629217682
Name:PAUL, AMANDA THOMASON (LCSW, MT-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:THOMASON
Last Name:PAUL
Suffix:
Gender:F
Credentials:LCSW, MT-BC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:DIANE
Other - Last Name:THOMASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:189 ADAM SHEPHERD PKWY STE 17
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6579
Mailing Address - Country:US
Mailing Address - Phone:502-640-3940
Mailing Address - Fax:
Practice Address - Street 1:4523 GREYMONT DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-3588
Practice Address - Country:US
Practice Address - Phone:502-640-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54281041C0700X
KY38131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical