Provider Demographics
NPI:1902288061
Name:MUSHRUSH, AMANDA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MUSHRUSH
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 1:637 LORD ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1713
Mailing Address - Country:US
Mailing Address - Phone:814-673-3823
Mailing Address - Fax:
Practice Address - Street 1:18278 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-8380
Practice Address - Country:US
Practice Address - Phone:814-332-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007341101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional