Provider Demographics
NPI:1669862637
Name:BOWLING, AMANDA JOY (LPC)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:JOY
Last Name:BOWLING
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 1:807 E WASHINGTON ST STE 150
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3339
Mailing Address - Country:US
Mailing Address - Phone:330-241-4444
Mailing Address - Fax:330-721-0013
Practice Address - Street 1:807 E WASHINGTON ST STE 150
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3339
Practice Address - Country:US
Practice Address - Phone:330-241-4444
Practice Address - Fax:330-721-0013
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400595101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC.1400595-TRNEOtherC.1400595-TRNE (COUNSELOR TRAINEE)