Provider Demographics
NPI:1689951360
Name:KOBOLD, AMY L (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:KOBOLD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:KEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1425 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2456
Mailing Address - Country:US
Mailing Address - Phone:419-693-0631
Mailing Address - Fax:419-936-7606
Practice Address - Street 1:1425 STARR AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2456
Practice Address - Country:US
Practice Address - Phone:419-693-0631
Practice Address - Fax:419-936-7606
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1000119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional