Provider Demographics
NPI:1720597503
Name:SEE, AMY M (LCDC-III)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:SEE
Suffix:
Gender:F
Credentials:LCDC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 GRASS RUN
Mailing Address - Street 2:
Mailing Address - City:NEW MARSHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45766-9727
Mailing Address - Country:US
Mailing Address - Phone:1740-856-9936
Mailing Address - Fax:
Practice Address - Street 1:11100 STATE ROUTE 550 STE H
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-592-1134
Practice Address - Fax:740-422-1513
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.163947101YA0400X
OHLCDCIII.161561101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)