Provider Demographics
NPI:1528001872
Name:TOLLE, AMY L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:TOLLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1200 E TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1234
Mailing Address - Country:US
Mailing Address - Phone:580-482-4095
Mailing Address - Fax:580-481-2499
Practice Address - Street 1:1200 E TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1234
Practice Address - Country:US
Practice Address - Phone:580-482-4095
Practice Address - Fax:580-481-2499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health