Provider Demographics
NPI:1508142977
Name:YOUNG NIBBER, AMANDA MEGAN (LPCC)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:MEGAN
Last Name:YOUNG NIBBER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-3587
Mailing Address - Country:US
Mailing Address - Phone:731-658-6113
Mailing Address - Fax:731-658-1597
Practice Address - Street 1:10710 OLD HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-3587
Practice Address - Country:US
Practice Address - Phone:731-658-6113
Practice Address - Fax:731-658-1597
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0144351101YM0800X
NMCCMH0217321101YP2500X
TNLPC7580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional