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General NPI Number Information
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NPI Number | 1184031817
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Entity Type | Individual
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Provider Name | AMANDA GRACE ORTT M.ED., LPCC, NCC
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Gender | Female
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 01/11/2020
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Provider Practice Location Address
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Address Line | 111 E WASHINGTON ST
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City | PRINCETON
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State | KY
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Zip | 42445-2249
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Country | US
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Telephone | 270-601-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 10867 HOPKINSVILLE RD
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City | PRINCETON
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State | KY
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Zip | 42445-6859
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Country | US
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Telephone | 270-963-0045
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Fax | 270-667-9065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1739
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License Number State | KY
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