Provider Demographics
NPI:1275738676
Name:BARTH, AMY L (LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:BARTH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174B S MORAINE VIEW PKWY
Mailing Address - Street 2:#201
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-2176
Mailing Address - Country:US
Mailing Address - Phone:708-785-0785
Mailing Address - Fax:
Practice Address - Street 1:174B S MORAINE VIEW PKWY
Practice Address - Street 2:#201
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-2176
Practice Address - Country:US
Practice Address - Phone:708-785-0785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5911-125101YP2500X
IL180005125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional