Healthcare Provider Details

I. General information

NPI: 1699518860
Provider Name (Legal Business Name): AMANDA LILLIAN RIFF LPAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S 3RD ST
LOUISVILLE KY
40203-2215
US

IV. Provider business mailing address

927 S 3RD ST
LOUISVILLE KY
40203-2215
US

V. Phone/Fax

Practice location:
  • Phone: 502-830-3137
  • Fax:
Mailing address:
  • Phone: 502-830-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number296624
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: