MEDICARE: DR. AMANDA M SEABOLT PH.D., PMHNP-BC, RN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704419865	MI
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0038240	OH
3	163WG0000X	General Practice Registered Nurse	RN.393970	OH

General Provider Information

NPI Number	:	1669113403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA M SEABOLT PH.D., PMHNP-BC, RN

Provider Business Mailing Address
First Line	:	7110 W CENTRAL AVE STE E
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-3115
Country	:	US
Telephone Number	:	419-266-0072
Fax Number	:	419-754-2306

Provider Business Practice Location Address
First Line	:	7110 W CENTRAL AVE STE E
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43617-3115
Country	:	US
Telephone Number	:	419-266-0072
Fax Number	:	419-754-2306

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	01/11/2026

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