Provider Demographics
NPI:1619157211
Name:PICKETT, AMY MARIE (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2075
Mailing Address - Country:US
Mailing Address - Phone:317-396-0683
Mailing Address - Fax:317-396-0687
Practice Address - Street 1:7830 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2075
Practice Address - Country:US
Practice Address - Phone:317-396-0683
Practice Address - Fax:317-396-0687
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000450A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health