Provider Demographics
NPI:1316578867
Name:FORDHAM, AMY ANNE (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ANNE
Last Name:FORDHAM
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HIGHWAY 52 N STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5825
Mailing Address - Country:US
Mailing Address - Phone:507-932-7321
Mailing Address - Fax:507-540-1285
Practice Address - Street 1:3800 HIGHWAY 52 N STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-5825
Practice Address - Country:US
Practice Address - Phone:507-932-7321
Practice Address - Fax:507-540-1285
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC2369101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health