Healthcare Provider Details

I. General information

NPI: 1578228235
Provider Name (Legal Business Name): AMANDA BROOKE KEFFNER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE KEFFNER

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 11/07/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 CAMINO REAL STE 404
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

5600 N FLAGLER DR APT 402
WEST PALM BEACH FL
33407-2647
US

V. Phone/Fax

Practice location:
  • Phone: 561-571-1557
  • Fax: 561-634-3537
Mailing address:
  • Phone: 732-779-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: