Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003363995 |
---|---|
Provider Name | Miss Amanda Conley |
First Address | Youngstown, OH 44501-0621 |
Second Address | Shaker Heights, OH 44122-5327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 08/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2847496 | (05) | OH |