Healthcare Provider Details

I. General information

NPI: 1568965408
Provider Name (Legal Business Name): AMANDA RENEE TORTORIGE LPC; LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MILE 187 GLENN HIGHWAY
GLENNALLEN AK
99588
US

IV. Provider business mailing address

PO BOX 5
GLENNALLEN AK
99588-0589
US

V. Phone/Fax

Practice location:
  • Phone: 706-386-7653
  • Fax:
Mailing address:
  • Phone: 907-822-3203
  • Fax: 833-819-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number149375
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016592
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013522
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: