MEDICARE: MRS. AMANDA GRACE ORTT M.ED., LPCC, NCC

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	101YP2500X	Professional Counselor	1739	KY

General Provider Information

NPI Number	:	1184031817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA GRACE ORTT M.ED., LPCC, NCC

Provider Business Mailing Address
First Line	:	10867 HOPKINSVILLE RD
Second Line	:
City	:	PRINCETON
State	:	KY
Zip	:	42445-6859
Country	:	US
Telephone Number	:	270-963-0045
Fax Number	:	270-667-9065

Provider Business Practice Location Address
First Line	:	111 E WASHINGTON ST
Second Line	:
City	:	PRINCETON
State	:	KY
Zip	:	42445-2249
Country	:	US
Telephone Number	:	270-601-6725
Fax Number	:

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	01/11/2020

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