Amanda Michele Pack, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071010371 Issued in IL

Practice address

20280 Governors Hwy Ste 105
Olympia Fields, IL 60461-1068

Phone

(312) 248-3481

NPI assigned

Oct 12, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Amanda Michele Long Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• True Space Counseling and Psychological Services

  • Psychologist
  • Olympia Fields, IL
  • NPI 1306516323
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755820800000",
    "number": "1083212005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22939 MILLARD AVE",
            "city": "RICHTON PARK",
            "state": "IL",
            "postal_code": "604712534",
            "telephone_number": "708-724-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20280 GOVERNORS HWY STE 105",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611068",
            "telephone_number": "312-248-3481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "AMANDA",
        "middle_name": "MICHELE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-12",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071010371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dr.amandalong@atruespace.com",
            "affiliation": "N",
            "endpointDescription": "Business Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "20280 Governors Hwy Ste 105",
            "city": "Olympia Fields",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604611068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "LONG",
            "middle_name": "MICHELE",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Open MRI of Olympia Fields, LLC
• Thomas Erastus Ortlieb Jr.
• Faizan Ali Osmani
• Emmanuel Otuwa
• Ina Pachwicewicz
• Eva Veronica Page, MD
• Christine Maureen Palicke, APN
• Miranda Palmer, OTD, OTR/L
• Katherine Ann Panice, FNP
• Roshan P Parikh, D.D.S.

• Clinical Psychologist in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.