Healthcare Provider Details

I. General information

NPI: 1134675226
Provider Name (Legal Business Name): AMANDA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 PINE HALL RD STE 100
STATE COLLEGE PA
16801-5107
US

IV. Provider business mailing address

168 WILSHIRE BLVD
JOHNSTOWN PA
15905-5900
US

V. Phone/Fax

Practice location:
  • Phone: 814-248-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC6107
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: