Provider Demographics
NPI:1891855144
Name:MERCHANT, AMANDA W (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:W
Last Name:MERCHANT
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:BLUEGRASS HEALTH PSYCHOLOGY, INC.
Mailing Address - Street 2:4101 TATES CREEK CTR DR, STE 150, PMB 123
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3066
Mailing Address - Country:US
Mailing Address - Phone:859-277-1008
Mailing Address - Fax:859-277-1083
Practice Address - Street 1:BLUEGRASS HEALTH PSYCHOLOGY, INC.
Practice Address - Street 2:2220 YOUNG DRIVE
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4219
Practice Address - Country:US
Practice Address - Phone:859-277-1008
Practice Address - Fax:859-277-1083
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1445103T00000X, 103TC0700X
KY129934103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100270170Medicaid