MEDICARE: AMANDA MARTIN ALC, MFT-I, NCC

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	101YP2500X	Professional Counselor	ALC04738	AL
2	106H00000X	Marriage & Family Therapist	I-126	AL

General Provider Information

NPI Number	:	1770326175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARTIN ALC, MFT-I, NCC

Provider Business Mailing Address
First Line	:	1401 PROVIDENCE PARK STE 250
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4787
Country	:	US
Telephone Number	:	205-440-1088
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 PROVIDENCE PARK STE 250
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4787
Country	:	US
Telephone Number	:	205-440-1088
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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