Healthcare Provider Details

I. General information

NPI: 1942450887
Provider Name (Legal Business Name): AMANDA KAY PIPINS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24919 S 4420 RD
VINITA OK
74301-5529
US

IV. Provider business mailing address

16756 HIGHWAY 2
BLUEJACKET OK
74333
US

V. Phone/Fax

Practice location:
  • Phone: 918-256-9125
  • Fax:
Mailing address:
  • Phone: 918-256-9125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4264
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: