Healthcare Provider Details

I. General information

NPI: 1225371214
Provider Name (Legal Business Name): AMANDA KAYE HALL LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HOPE ST
MOUNT WASHINGTON KY
40047-7757
US

IV. Provider business mailing address

PO BOX 1429
MT WASHINGTON KY
40047-1429
US

V. Phone/Fax

Practice location:
  • Phone: 502-538-1200
  • Fax: 502-538-1201
Mailing address:
  • Phone: 502-538-1200
  • Fax: 502-538-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberKY-1009
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: