Provider Demographics
NPI:1205981909
Name:LUKEHART, AMANDA V (MS LPC)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:V
Last Name:LUKEHART
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S GILLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4807
Mailing Address - Country:US
Mailing Address - Phone:307-660-5876
Mailing Address - Fax:307-686-2587
Practice Address - Street 1:908 S GILLETTE AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4807
Practice Address - Country:US
Practice Address - Phone:307-660-5876
Practice Address - Fax:307-686-2587
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC 1466101YM0800X, 101YP2500X
WYPPC 246101YP2500X
NCNCC202665101YP2500X
251C00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251C00000XAgenciesDay Training, Developmentally Disabled Services