Healthcare Provider Details

I. General information

NPI: 1750126231
Provider Name (Legal Business Name): AMANDA MCKINNEY LISW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27540 DETROIT RD STE 103
WESTLAKE OH
44145-2299
US

IV. Provider business mailing address

27540 DETROIT RD STE 103
WESTLAKE OH
44145-2299
US

V. Phone/Fax

Practice location:
  • Phone: 513-549-5689
  • Fax: 440-287-6117
Mailing address:
  • Phone: 513-549-5689
  • Fax: 440-287-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMANDA THOME
Title or Position: OWNER, THERAPIST
Credential: LISW-S
Phone: 513-549-5689