Amanda Domangue Bourg, PHD is a medicare enrolled "Psychologist - Counseling" provider in Tellico Plains, Tennessee. Her current practice location is
171 Bank St # 221, Tellico Plains, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(443) 379-0447.
Amanda Domangue Bourg is licensed to practice in Tennessee (license number 3783) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1386758068.
Healthcare Provider's Profile
| Full Name | Amanda Domangue Bourg |
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| Gender | Female |
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| Speciality | |
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| Experience | Years |
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| Location | 171 Bank St # 221, Tellico Plains, Tennessee |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Amanda Domangue Bourg attended and graduated from in
NPI Data:
- NPI Number: 1386758068
- Provider Enumeration Date: 08/18/2006
- Last Update Date: 10/13/2022
Medicare PECOS Information:
- PECOS PAC ID:
- Enrollment ID:
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
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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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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