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General NPI Number Information
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NPI Number | 1346874617
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Entity Type | Organization
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Legal Business Name | AMANDA LAMP, MSW
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 3030 S INVERNESS FARM RD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-9110
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Country | US
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Telephone | 229-460-8186
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Fax |
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Provider Business Mailing Address
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Address Line | 3030 S INVERNESS FARM RD
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City | BLOOMINGTON
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State | IN
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Zip | 47401-9110
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Country | US
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Telephone | 229-460-8186
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL CONSULTANT
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Name | AMANDA LAMP
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Credential | MSW
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Telephone | 229-460-8186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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