Provider Demographics
NPI:1073130910
Name:SOWELL, AMY (LPC-CANDIDATE)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SOWELL
Suffix:
Gender:F
Credentials:LPC-CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 NW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7603
Mailing Address - Country:US
Mailing Address - Phone:754-204-8353
Mailing Address - Fax:
Practice Address - Street 1:4911 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6171
Practice Address - Country:US
Practice Address - Phone:405-751-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health