Healthcare Provider Details

I. General information

NPI: 1841678521
Provider Name (Legal Business Name): AMANDA MARIE BARLOW LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE HART MA, LPC

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 E TUDOR RD STE 100
ANCHORAGE AK
99503-6123
US

IV. Provider business mailing address

7033 E TUDOR RD
ANCHORAGE AK
99507-1262
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-8961
  • Fax: 907-729-5180
Mailing address:
  • Phone: 907-729-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11503
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 13252
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2022-0272
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number115272
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: