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General NPI Number Information
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NPI Number | 1184466450
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Entity Type | Individual
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Provider Name | AMANDA MCILVOY
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Gender | Female
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Dates
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Enumeration Date | 06/08/2024
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Last Update Date | 06/08/2024
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Provider Practice Location Address
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Address Line | 121 S PUBLIC SQ
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City | GREENSBURG
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State | KY
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Zip | 42743-1532
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Country | US
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Telephone | 502-203-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 69 WILLIS LN
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City | SPRINGFIELD
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State | KY
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Zip | 40069-9444
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 291769
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License Number State | KY
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