MEDICARE: AMANDA KIRK

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	MH21405	FL

General Provider Information

NPI Number	:	1568170272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KIRK

Provider Business Mailing Address
First Line	:	160 MLK BLVD NE # 446
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 MLK BLVD NE # 446
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-2419
Country	:	US
Telephone Number	:	256-570-7988
Fax Number	:

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

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	11/10/2022

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Directions to “ AMANDA KIRK ” Practice Location

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