Provider Demographics
NPI:1144380353
Name:LOUNSBURY-ENK, AMY (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LOUNSBURY-ENK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LOUNSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:912 NE KELLY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5637
Mailing Address - Country:US
Mailing Address - Phone:503-258-4600
Mailing Address - Fax:
Practice Address - Street 1:912 NE KELLY AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-258-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 14618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ200908Medicaid