Provider Demographics
NPI:1932666054
Name:BRIDGES, AMANDA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1094
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-1094
Mailing Address - Country:US
Mailing Address - Phone:816-872-4623
Mailing Address - Fax:
Practice Address - Street 1:7 E KANSAS ST STE C
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2312
Practice Address - Country:US
Practice Address - Phone:816-592-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016992101YP2500X
MO2020010639101YP2500X
IL180.011694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional