Provider Demographics
NPI:1346611605
Name:PUGH, AMY RENEE (LSCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:PUGH
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12502 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056-9386
Mailing Address - Country:US
Mailing Address - Phone:316-200-2233
Mailing Address - Fax:
Practice Address - Street 1:2919 W 2ND ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5319
Practice Address - Country:US
Practice Address - Phone:316-200-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical