Provider Demographics
NPI:1992003883
Name:SCOTT, AMANDA LEA (LPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8317
Mailing Address - Country:US
Mailing Address - Phone:208-322-5859
Mailing Address - Fax:208-322-5901
Practice Address - Street 1:8400 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8317
Practice Address - Country:US
Practice Address - Phone:208-322-5859
Practice Address - Fax:208-322-5901
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional