Provider Demographics
NPI:1891983383
Name:PELLINGTON, AMANDA JEAN (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JEAN
Last Name:PELLINGTON
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 BARCLAY DR APT 106
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-4163
Mailing Address - Country:US
Mailing Address - Phone:727-643-2615
Mailing Address - Fax:
Practice Address - Street 1:2801 E LAKE RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1813
Practice Address - Country:US
Practice Address - Phone:727-784-9250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health