Provider Demographics
NPI:1114374253
Name:FOOTE, AMY ELSE (LPC, NCC, MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELSE
Last Name:FOOTE
Suffix:
Gender:F
Credentials:LPC, NCC, MS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:ELSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 E 10TH AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3273
Mailing Address - Country:US
Mailing Address - Phone:541-687-6983
Mailing Address - Fax:
Practice Address - Street 1:360 E 10TH AVE STE 450
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3273
Practice Address - Country:US
Practice Address - Phone:541-687-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC5226101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500708537Medicaid