MEDICARE: AMANDA C MASSEY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255588570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA C MASSEY

Provider Business Mailing Address
First Line	:	615 N ALABAMA ST STE 320
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1432
Country	:	US
Telephone Number	:	317-634-6341
Fax Number	:	317-464-9575

Provider Business Practice Location Address
First Line	:	615 N ALABAMA ST STE 320
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1432
Country	:	US
Telephone Number	:	317-634-6341
Fax Number	:	317-464-9575

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	08/19/2008

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Directions to “ AMANDA C MASSEY ” Practice Location

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