Provider Demographics
NPI:1346717055
Name:CLOSE, AMY LYN (LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYN
Last Name:CLOSE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 NIAGARA FALLS BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6494
Mailing Address - Country:US
Mailing Address - Phone:315-283-1947
Mailing Address - Fax:
Practice Address - Street 1:1868 NIAGARA FALLS BLVD STE 305
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-6494
Practice Address - Country:US
Practice Address - Phone:315-283-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty