Provider Demographics
NPI:1851073175
Name:HARRIS, AMANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 STATE ROUTE 1763
Mailing Address - Street 2:
Mailing Address - City:WINGO
Mailing Address - State:KY
Mailing Address - Zip Code:42088-9356
Mailing Address - Country:US
Mailing Address - Phone:270-705-9003
Mailing Address - Fax:
Practice Address - Street 1:2620 PERKINS CREEK DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7494
Practice Address - Country:US
Practice Address - Phone:270-444-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2557271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical