MEDICARE: AMANDA DILLOW MA, NCC, LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	279020	KY

General Provider Information

NPI Number	:	1003450578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA DILLOW MA, NCC, LPCC

Provider Business Mailing Address
First Line	:	920 FREDERICA ST STE 309
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3078
Country	:	US
Telephone Number	:	270-316-3303
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 FREDERICA ST STE 309
Second Line	:
City	:	OWENSBORO
State	:	KY
Zip	:	42301-3078
Country	:	US
Telephone Number	:	270-316-3303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	03/19/2024

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