Healthcare Provider Details

I. General information

NPI: 1285777177
Provider Name (Legal Business Name): AMANDA JILL MCGREW LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 N BLACK BRANCH RD
CECILIA KY
42724-9522
US

IV. Provider business mailing address

162 N BLACK BRANCH RD
CECILIA KY
42724-9522
US

V. Phone/Fax

Practice location:
  • Phone: 270-401-1104
  • Fax:
Mailing address:
  • Phone: 270-401-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number170685
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: