Provider Demographics
NPI:1023840600
Name:HENRY, AMANDA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:HENRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORPORATE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-7941
Mailing Address - Country:US
Mailing Address - Phone:814-709-9819
Mailing Address - Fax:814-310-2355
Practice Address - Street 1:1 CORPORATE DR STE 107
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-7941
Practice Address - Country:US
Practice Address - Phone:814-709-9819
Practice Address - Fax:814-310-2355
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health