Basic Information
Provider Information
NPI: 1801964820
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: AMANDA
MiddleName: LYNN
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2345 S LYNHURST DR
Address2: SUITE 205
City: INDIANAPOLIS
State: IN
PostalCode: 462418630
CountryCode: US
TelephoneNumber: 3172478900
FaxNumber: 3172478935
Practice Location
Address1: 2345 S LYNHURST DR
Address2: SUITE 205
City: INDIANAPOLIS
State: IN
PostalCode: 462418630
CountryCode: US
TelephoneNumber: 3172478900
FaxNumber: 3172478935
Other Information
ProviderEnumerationDate: 11/30/2006
LastUpdateDate: 08/07/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home