Provider Demographics
NPI:1669001236
Name:VILLARREAL, AMANDA VANESSA (TCM)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:VANESSA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:TCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-2134
Mailing Address - Country:US
Mailing Address - Phone:859-619-2711
Mailing Address - Fax:
Practice Address - Street 1:1353 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2065
Practice Address - Country:US
Practice Address - Phone:855-591-0092
Practice Address - Fax:502-631-9660
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator