Provider Demographics
NPI:1043945835
Name:AMANDA LYNNE, PHD, LLC
Entity type:Organization
Organization Name:AMANDA LYNNE, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:QUINBY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSPP
Authorized Official - Phone:812-606-2919
Mailing Address - Street 1:205 N COLLEGE AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3953
Mailing Address - Country:US
Mailing Address - Phone:812-606-2919
Mailing Address - Fax:812-901-6614
Practice Address - Street 1:205 N COLLEGE AVE STE 314
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3953
Practice Address - Country:US
Practice Address - Phone:812-606-2919
Practice Address - Fax:812-901-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty