Provider Demographics
NPI:1114535127
Name:LEWIS-YARBROUGH, AMANDA (PHD)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LEWIS-YARBROUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4900
Mailing Address - Country:US
Mailing Address - Phone:334-398-8516
Mailing Address - Fax:888-800-3749
Practice Address - Street 1:141 MARKET PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4900
Practice Address - Country:US
Practice Address - Phone:334-398-8516
Practice Address - Fax:888-800-3749
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
AL2256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty