Healthcare Provider Details

I. General information

NPI: 1265815351
Provider Name (Legal Business Name): AMANDA PATTERSON, LMHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 308
DAVIE FL
33328-5310
US

IV. Provider business mailing address

5400 S UNIVERSITY DR STE 308
DAVIE FL
33328-5310
US

V. Phone/Fax

Practice location:
  • Phone: 543-785-3819
  • Fax:
Mailing address:
  • Phone: 954-378-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10243
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMH10243
License Number StateFL

VIII. Authorized Official

Name: AMANDA PATTERSON
Title or Position: OWNER
Credential: LMHC
Phone: 954-258-8845