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General NPI Number Information
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NPI Number | 1932666054
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Entity Type | Individual
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Provider Name | AMANDA LYNN BRIDGES LPC
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Gender | Female
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 7 E KANSAS ST STE C
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City | LIBERTY
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State | MO
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Zip | 64068-2312
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Country | US
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Telephone | 816-592-3848
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1094
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City | KEARNEY
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State | MO
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Zip | 64060-1094
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Country | US
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Telephone | 816-872-4623
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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 | 6401016992
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2020010639
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.011694
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License Number State | IL
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