MEDICARE: AMANDA STAYTON MA, LPCC

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	E.0900112	OH

General Provider Information

NPI Number	:	1255646535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA STAYTON MA, LPCC

Provider Business Mailing Address
First Line	:	8809 CINCINNATI DAYTON RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3134
Country	:	US
Telephone Number	:	513-969-9058
Fax Number	:

Provider Business Practice Location Address
First Line	:	8809 CINCINNATI DAYTON RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3134
Country	:	US
Telephone Number	:	513-969-9058
Fax Number	:

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

Provider Enumeration Date	:	08/11/2010
Last Update Date	:	06/20/2024

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