Provider Demographics
NPI:1811226947
Name:BITTNER, AMANDA KAYE (PHD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KAYE
Last Name:BITTNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S HANLEY RD STE 195
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1520
Mailing Address - Country:US
Mailing Address - Phone:618-973-4863
Mailing Address - Fax:
Practice Address - Street 1:2001 S HANLEY RD STE 195
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1520
Practice Address - Country:US
Practice Address - Phone:618-973-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-20
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011193101YP2500X
MO2010009075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional