Provider Demographics
NPI:1629409479
Name:AVERY, AMY (LPCC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9230 RAMI AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2158
Mailing Address - Country:US
Mailing Address - Phone:614-905-1868
Mailing Address - Fax:614-416-0345
Practice Address - Street 1:1900 POLARIS PKWY STE 450
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4064
Practice Address - Country:US
Practice Address - Phone:614-905-1868
Practice Address - Fax:614-416-0345
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHE.1400012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty