Provider Demographics
NPI:1275962458
Name:WILSON, AMIE JO (LPCC)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:JO
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7757
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:502-538-1100
Practice Address - Street 1:500 NEW START RD
Practice Address - Street 2:
Practice Address - City:BRONSTON
Practice Address - State:KY
Practice Address - Zip Code:42518-8572
Practice Address - Country:US
Practice Address - Phone:606-561-5797
Practice Address - Fax:606-561-9928
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health