Provider Demographics
NPI:1962807081
Name:AMANDA LITTELL
Entity type:Organization
Organization Name:AMANDA LITTELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LITTELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:219-741-1632
Mailing Address - Street 1:360 E SOUTH WATER ST APT 803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4120
Mailing Address - Country:US
Mailing Address - Phone:219-741-1632
Mailing Address - Fax:
Practice Address - Street 1:360 E SOUTH WATER ST APT 803
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4120
Practice Address - Country:US
Practice Address - Phone:219-741-1632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149017068251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health