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General NPI Number Information
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NPI Number | 1043945835
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Entity Type | Organization
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Legal Business Name | AMANDA LYNNE, PHD, LLC
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 205 N COLLEGE AVE STE 314
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3953
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Country | US
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Telephone | 812-606-2919
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Fax | 812-901-6614
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Provider Business Mailing Address
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Address Line | 205 N COLLEGE AVE STE 314
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3953
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Country | US
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Telephone | 812-606-2919
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Fax | 812-901-6614
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Authorized Official
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Title or Position | OWNER, PSYCHOLOGIST
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Name | AMANDA LYNNE QUINBY
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Credential | PHD, HSPP
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Telephone | 812-606-2919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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