Bourg, Amanda Domangue

Bourg, Amanda Domangue is an individual health care provider with primary practice located at 171 Bank St # 221 , Tellico Plains TN 37385-4987. She recently has only one registered license in Behavioral Health & Social Service Providers / Counseling, which is considered as her primary health care specialty. Bourg, Amanda Domangue can be contacted via phone (443) 379-0447.

Contact Information

Primary practice address
171 Bank St # 221 Tellico Plains TN 37385-4987
Phone: (443) 379-0447
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counseling 103TC1900X 3783 Tennessee
Behavioral Health & Social Service Providers / Counseling 103TC1900X 915 Louisiana

Profile Details

NPI number 1386758068
LBN Legal business name Bourg, Amanda Domangue
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 18th, 2006
Last updated Oct 13th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386758068 NPPES
Louisiana Other 915 STATE PSYCHOLOGY LICENSE
Louisiana Other 3783 STATE PSYCHOLOGY LICENSE

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