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NPI Code Detail

MEDICARE: AMANDA ATKINS, LLC

MEDICARE: AMANDA ATKINS, LLC
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
1106H00000XMarriage & Family Therapist166000968IL

General Provider Information

NPI Number : 1184092413
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMANDA ATKINS, LLC
Provider Business Mailing Address
First Line : 4503 N WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-2116
Country : US
Telephone Number : 312-401-6574
Fax Number :
Provider Business Practice Location Address
First Line : 4050 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-3067
Country : US
Telephone Number : 312-401-6574
Fax Number :
Authorized Official
Title or Position : OWNER/THERAPIST
Name : MRS. AMANDA JO ATKINS
Credential : LMFT
Telephone Number : 312-401-6574
Provider Enumeration Date : 09/03/2015
Last Update Date : 09/03/2015

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