Provider Demographics
NPI:1114464203
Name:AMTOWER, STEVEN R (MA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:AMTOWER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3520
Mailing Address - Country:US
Mailing Address - Phone:304-788-1113
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3520
Practice Address - Country:US
Practice Address - Phone:304-788-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2393101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2393OtherWV BOARD OF EXAMINERS IN COUNSELING