Provider Demographics
NPI:1578015442
Name:AMY CORMAN, LLC
Entity Type:Organization
Organization Name:AMY CORMAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:509-251-3062
Mailing Address - Street 1:38811 N GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-9528
Mailing Address - Country:US
Mailing Address - Phone:509-251-3062
Mailing Address - Fax:
Practice Address - Street 1:316 W BOONE AVE
Practice Address - Street 2:SUITE 656
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2354
Practice Address - Country:US
Practice Address - Phone:509-251-3062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60290564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174845267OtherNPI NUMBER THROUGH LUTHERAN COMMUNITY SERVICES NORTHWEST