Amanda Matthews-Hargrave, LMHC, LCAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39001856A Issued in IN

Practice address

1 W Jackson St
Sullivan, IN 47882-1503

Phone

(812) 905-0182

Fax

(812) 268-6767

NPI assigned

Mar 8, 2007

Last updated

Nov 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1174654644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 W JACKSON ST",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478821503",
            "telephone_number": "812-905-0182",
            "fax_number": "812-268-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 W JACKSON ST",
            "city": "SULLIVAN",
            "state": "IN",
            "postal_code": "478821503",
            "telephone_number": "812-905-0182",
            "fax_number": "812-268-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTHEWS-HARGRAVE",
        "first_name": "AMANDA",
        "name_prefix": "Mrs.",
        "credential": "LMHC, LCAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IN",
            "license": "87001130A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39001856A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanna Rennee Lisman, APN
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• Medlife Inc
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• Mso Clinics, Inc. (Lakeside Family Medical)

• Mental Health Counselor in Sullivan, IN
• Providers in Sullivan, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.