Provider Demographics
NPI:1508234618
Name:ROTZ, AMY (LMFTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROTZ
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 30TH AVE
Mailing Address - Street 2:APT A
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6227
Mailing Address - Country:US
Mailing Address - Phone:360-305-4622
Mailing Address - Fax:
Practice Address - Street 1:1715 114TH AVE SE
Practice Address - Street 2:SUITE 208
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6945
Practice Address - Country:US
Practice Address - Phone:360-305-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60566355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMG60566355OtherLMFTA ASSOCIATE CREDENTIAL