| Doctor Name: | AMANDA LENORA |
| NPI Number: | 1396105391 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 221 N Wewoka Ave Wewoka, OK - 748842221 |
| Business Phone Number: | 4052579030 |
| Business Fax Number: | 4052579031 |
| Mailing Address: | Po Box 662, PURCELL |
| State: | OK |
| Postal Code: | 730800662 |
| Phone Number: | 4055271785 |
| Fax Number: | 4055271084 |
| NPI Enumeration Date: | 03/03/2016 |
| NPI Last Update Date: | 03/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |