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NPI Code Detail

MEDICARE: AMANDA MITCHELL CSW

MEDICARE: AMANDA MITCHELL CSW
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
11041C0700XClinical Social Worker254275KY

General Provider Information

NPI Number : 1689219305
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA MITCHELL CSW
Provider Business Mailing Address
First Line : 380 SUWANNEE TRAIL ST
Second Line :
City : BOWLING GREEN
State : KY
Zip : 42103-7956
Country : US
Telephone Number : 270-901-5000
Fax Number : 270-842-5268
Provider Business Practice Location Address
First Line : 512 VETERANS MEMORIAL HWY
Second Line :
City : SCOTTSVILLE
State : KY
Zip : 42164-8443
Country : US
Telephone Number : 270-901-5000
Fax Number : 270-842-5268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2019
Last Update Date : 11/18/2019

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Directions to “ AMANDA MITCHELL CSW” Practice Location

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