MEDICARE: AMANDA MCKINNEY LISW, LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750126231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA MCKINNEY LISW, LLC

Provider Business Mailing Address
First Line	:	27540 DETROIT RD STE 103
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2299
Country	:	US
Telephone Number	:	513-549-5689
Fax Number	:	440-287-6117

Provider Business Practice Location Address
First Line	:	27540 DETROIT RD STE 103
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-2299
Country	:	US
Telephone Number	:	513-549-5689
Fax Number	:	440-287-6117

Authorized Official
Title or Position	:	OWNER, THERAPIST
Name	:	AMANDA THOME
Credential	:	LISW-S
Telephone Number	:	513-549-5689

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	03/14/2026

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