Provider Demographics
NPI:1689065310
Name:CORRIGAN, AMANDA (IMFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CORRIGAN
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2195
Mailing Address - Country:US
Mailing Address - Phone:614-955-1023
Mailing Address - Fax:
Practice Address - Street 1:3 W MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2195
Practice Address - Country:US
Practice Address - Phone:614-955-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM 1300029106H00000X
OHF.1700002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist