Healthcare Provider Details

I. General information

NPI: 1669725107
Provider Name (Legal Business Name): AMANDA STRATTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 3014
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-517-0860
Mailing address:
  • Phone: 513-636-4788
  • Fax: 513-517-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number091117
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE 0701072
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0701072
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: