Provider Demographics
NPI:1881168631
Name:CHILES, AMANDA J (MSED, LPCC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:CHILES
Suffix:
Gender:F
Credentials:MSED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N OTTERBEIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5719
Mailing Address - Country:US
Mailing Address - Phone:614-259-8605
Mailing Address - Fax:
Practice Address - Street 1:120 N OTTERBEIN AVE
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5719
Practice Address - Country:US
Practice Address - Phone:614-259-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2505396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health