Provider Demographics
NPI:1710234661
Name:ICE, AMY MICHELLE (MA, CRC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:ICE
Suffix:
Gender:F
Credentials:MA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N ARMENIA AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6400
Mailing Address - Country:US
Mailing Address - Phone:813-872-8521
Mailing Address - Fax:813-200-3707
Practice Address - Street 1:4144 N ARMENIA AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6400
Practice Address - Country:US
Practice Address - Phone:813-872-8521
Practice Address - Fax:813-200-3707
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health