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General NPI Number Information
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NPI Number | 1336726900
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Entity Type | Individual
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Provider Name | AMANDA COURTNEY LSW MSW CMHT
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Gender | Female
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Dates
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Enumeration Date | 03/28/2021
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 3049 REFUGE LN NE
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City | WESSON
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State | MS
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Zip | 39191-6201
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Country | US
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Telephone | 601-259-0623
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Fax |
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Provider Business Mailing Address
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Address Line | 3049 REFUGE LN NE
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City | WESSON
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State | MS
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Zip | 39191-6201
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150115781
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PH4289
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License Number State | MS
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