Healthcare Provider Details

I. General information

NPI: 1033635453
Provider Name (Legal Business Name): AMANDA BRUMFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3086 STATE ROUTE 160
GALLIPOLIS OH
45631
US

IV. Provider business mailing address

3086 STATE ROUTE 160
GALLIPOLIS OH
45631-8409
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5500
  • Fax: 740-446-2159
Mailing address:
  • Phone: 740-446-5500
  • Fax: 740-446-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2404821
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1302526
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: