Amanda Domangue Bourg, PHD is a
Psychologist - Counseling based in Tellico Plains, Tennessee. Amanda Domangue Bourg is licensed to practice in Tennessee (license number 3783) and her current practice location is
171 Bank St # 221, Tellico Plains, Tennessee. She can be reached at her office (for appointments etc.) via phone at
(443) 379-0447.
NPI number for Amanda Domangue Bourg is 1386758068 and her current mailing address is Po Box 221, Tellico Plains, Tennessee. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1386758068.
Healthcare Provider's Profile
| Full Name | Amanda Domangue Bourg |
|---|
| Gender | Female |
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| Speciality | Psychologist - Counseling |
|---|
| Location | 171 Bank St # 221, Tellico Plains, Tennessee |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1386758068
- Provider Enumeration Date: 08/18/2006
- Last Update Date: 10/13/2022
Medical Identifiers
Medical identifiers for Amanda Domangue Bourg such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1386758068 | NPI | - | NPPES |
| 915 | Other | LA | STATE PSYCHOLOGY LICENSE |
| 3783 | Other | TN | STATE PSYCHOLOGY LICENSURE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC1900X | Psychologist - Counseling | 3783 (Tennessee) | Primary |
| 103TC1900X | Psychologist - Counseling | 915 (Louisiana) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Amanda Domangue Bourg is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Amanda Domangue Bourg, PHD
Po Box 221,
Tellico Plains, TN 37385-0221
Ph: () - | Amanda Domangue Bourg, PHD
171 Bank St # 221,
Tellico Plains, TN 37385-4987
Ph: (443) 379-0447 |
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