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General NPI Number Information
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NPI Number | 1396439592
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Entity Type | Individual
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Provider Name | AMANDA GRACE GAROUTTE-MOHAMMED LPC-IT
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Gender | Female
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | N19W24400 RIVERWOOD DR STE 350
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City | WAUKESHA
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State | WI
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Zip | 53188-1182
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Country | US
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Telephone | 262-573-7344
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Fax |
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Provider Business Mailing Address
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Address Line | N19W24400 RIVERWOOD DR STE 350-441
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City | WAUKESHA
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State | WI
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Zip | 53188-1166
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Country | US
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Telephone | 262-573-7344
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5468-226
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License Number State | WI
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