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General NPI Number Information
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NPI Number | 1366331480
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Entity Type | Organization
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Legal Business Name | GREEN AMPERSAND PSYCHOLOGY LLC
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 4775 ORCHARD RUN RD #277
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City | DAYTON
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State | OH
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Zip | 45449-4544
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Country | US
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Telephone | 614-465-6954
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Fax | 614-465-6955
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Provider Business Mailing Address
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Address Line | 4775 ORCHARD RUN RD #277
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City | DAYTON
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State | OH
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Zip | 45449
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Country | US
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Telephone | 614-465-6954
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Fax | 614-940-4718
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMANDA M SHEA
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Credential | PHD
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Telephone | 614-465-6954
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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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