Provider Demographics
NPI:1427484948
Name:KERN, AMANDA L (LCPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:KERN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 B ST S
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-9460
Mailing Address - Country:US
Mailing Address - Phone:406-369-2839
Mailing Address - Fax:406-213-7790
Practice Address - Street 1:605 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2812
Practice Address - Country:US
Practice Address - Phone:406-369-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health