Provider Demographics
NPI:1558006924
Name:GOURLEY, AMYE RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMYE
Middle Name:RENEE
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 E DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8733
Mailing Address - Country:US
Mailing Address - Phone:574-806-4357
Mailing Address - Fax:
Practice Address - Street 1:11060 E DIVISION RD
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8733
Practice Address - Country:US
Practice Address - Phone:574-806-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009709A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical