MEDICARE: AMANDA KATHERINE CAMPBELL MADDC II

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	101Y00000X	Counselor	2024049781	MO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	18254	MO
3	101YM0800X	Mental Health Counselor	2024049781	MO
4	101YP2500X	Professional Counselor	2024049781	MO

General Provider Information

NPI Number	:	1801625298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA KATHERINE CAMPBELL MADDC II

Provider Business Mailing Address
First Line	:	PO BOX 826
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65615-0826
Country	:	US
Telephone Number	:	417-231-9687
Fax Number	:

Provider Business Practice Location Address
First Line	:	11016 E STATE HIGHWAY 76
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-9775
Country	:	US
Telephone Number	:	417-231-9687
Fax Number	:

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

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	05/15/2025

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