Healthcare Provider Details

I. General information

NPI: 1891495693
Provider Name (Legal Business Name): AMANDA WALTER MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S MAIN ST
DOYLESTOWN PA
18901-4815
US

IV. Provider business mailing address

275 S MAIN ST STE 8
DOYLESTOWN PA
18901-4815
US

V. Phone/Fax

Practice location:
  • Phone: 215-220-4500
  • Fax:
Mailing address:
  • Phone: 267-405-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberPC015379
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: