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NPI Code Detail

MEDICARE: MS. AMANDA RENAE LILE

MEDICARE: MS. AMANDA RENAE LILE
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
1101YP2500XProfessional CounselorOK

General Provider Information

NPI Number : 1396602884
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA RENAE LILE
Provider Business Mailing Address
First Line : 9608 SULTANS WATER WAY
Second Line :
City : YUKON
State : OK
Zip : 73099-7894
Country : US
Telephone Number : 405-603-3265
Fax Number :
Provider Business Practice Location Address
First Line : 3908 N PENIEL AVE STE 500
Second Line :
City : BETHANY
State : OK
Zip : 73008-3402
Country : US
Telephone Number : 405-603-3265
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ MS. AMANDA RENAE LILE ” Practice Location

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