Provider Demographics
NPI:1447831300
Name:LOUIS, AMANDA KELLY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:KELLY
Last Name:LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 NW 83RD TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2932
Mailing Address - Country:US
Mailing Address - Phone:954-822-1682
Mailing Address - Fax:
Practice Address - Street 1:3833 NW 83RD TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-2932
Practice Address - Country:US
Practice Address - Phone:954-822-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst