Provider Demographics
NPI:1831076355
Name:RANDOLPH, AMANDA LYNN (PLMHP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:RANDOLPH
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N 35TH ST APT 13
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-0652
Mailing Address - Country:US
Mailing Address - Phone:712-314-8617
Mailing Address - Fax:712-314-8617
Practice Address - Street 1:520 N 7TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0709
Practice Address - Country:US
Practice Address - Phone:712-406-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE14491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health