Provider Demographics
NPI:1982029773
Name:AMANDA LUKEHART AND ROBBIE HOLDEMAN LLC
Entity Type:Organization
Organization Name:AMANDA LUKEHART AND ROBBIE HOLDEMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER/OWNER/MEMEBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:307-660-2773
Mailing Address - Street 1:510 S BROOKS AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4013
Mailing Address - Country:US
Mailing Address - Phone:307-660-2773
Mailing Address - Fax:307-686-2587
Practice Address - Street 1:510 S BROOKS AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4013
Practice Address - Country:US
Practice Address - Phone:307-660-2773
Practice Address - Fax:307-686-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1396976023Medicaid
WY1205981909Medicaid