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NPI Code Detail

MEDICARE: AMANDA EVANGELINE CLELAND

MEDICARE: AMANDA EVANGELINE CLELAND
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1457970204
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA EVANGELINE CLELAND
Provider Business Mailing Address
First Line : 615 PRIDE DR
Second Line :
City : HAMMOND
State : LA
Zip : 70401-9523
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 615 PRIDE DR
Second Line :
City : HAMMOND
State : LA
Zip : 70401-9523
Country : US
Telephone Number : 985-419-1666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2020
Last Update Date : 04/13/2020

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Directions to “ AMANDA EVANGELINE CLELAND ” Practice Location

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