Provider Demographics
NPI:1639636475
Name:MCMULLAN, AMY COBB (LPCA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:COBB
Last Name:MCMULLAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:MCMULLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 DORAL CT
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-9045
Mailing Address - Country:US
Mailing Address - Phone:502-423-1123
Mailing Address - Fax:
Practice Address - Street 1:310 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1026
Practice Address - Country:US
Practice Address - Phone:502-423-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional