MEDICARE: AMANDA PARKS M.ED, CRC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-1791	WY

General Provider Information

NPI Number	:	1144881632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA PARKS M.ED, CRC, LPC

Provider Business Mailing Address
First Line	:	1326 N HEIGHTS RD
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-2129
Country	:	US
Telephone Number	:	702-715-2599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1326 N HEIGHTS RD
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-2129
Country	:	US
Telephone Number	:	702-715-2599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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