Healthcare Provider Details

I. General information

NPI: 1770311102
Provider Name (Legal Business Name): AMANDA LEE MCGUIRE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LEE ELFTMAN

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 W LOOMIS RD STE 120
GREENFIELD WI
53221-2057
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 414-424-2445
  • Fax: 414-424-2446
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11209
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11209
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: