Provider Demographics
NPI:1639342421
Name:GOULD, AMY LYNN (LPCC-S)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:GOULD
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 GREEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5715
Mailing Address - Country:US
Mailing Address - Phone:216-401-7433
Mailing Address - Fax:855-860-1978
Practice Address - Street 1:3659 GREEN RD STE 101
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5715
Practice Address - Country:US
Practice Address - Phone:216-401-7433
Practice Address - Fax:855-860-1978
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0602179 SUPV101YP2500X
OHE.0602179-SUPV101YM0800X
OHE.0602179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450404Medicaid
OH0279728Medicaid