Active NPI
Amanda Jo Samudio, LPCCCA
- Professional Counselor
- Lexington, KY
National Provider Identifier
1497133359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPCCCA00216359
- Practice address
- 3439 Buckhorn Dr
Suite 160
Lexington, KY 40515-1716 - Phone
- (859) 721-1636
- NPI assigned
- May 12, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPCCCA00216359 | KY | Primary |
Addresses
Primary practice location
3439 Buckhorn Dr
Suite 160
Lexington, KY 40515-1716
Mailing address
3439 Buckhorn Dr
Suite 160
Lexington, KY 40515-1716
Phone (859) 721-1636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPCCCA00216359 | KY | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431388800000",
"number": "1497133359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3439 BUCKHORN DR",
"address_2": "SUITE 160",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405151716",
"telephone_number": "859-721-1636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3439 BUCKHORN DR",
"address_2": "SUITE 160",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405151716",
"telephone_number": "859-721-1636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUDIO",
"first_name": "AMANDA",
"middle_name": "JO",
"credential": "LPCCCA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-12",
"last_updated": "2015-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "LPCCCA00216359",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.