MEDICARE: MS. AMANDA JEAN PELLINGTON MS, LMHC

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	101YM0800X	Mental Health Counselor	MH9007	FL

General Provider Information

NPI Number	:	1891983383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA JEAN PELLINGTON MS, LMHC

Provider Business Mailing Address
First Line	:	4979 BARCLAY DR APT 106
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-4163
Country	:	US
Telephone Number	:	727-643-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1813
Country	:	US
Telephone Number	:	727-784-9250
Fax Number	:

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

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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