Provider Demographics
NPI:1871033134
Name:ADAMS, AMY LYNN
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27821 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4238
Mailing Address - Country:US
Mailing Address - Phone:239-800-9719
Mailing Address - Fax:
Practice Address - Street 1:780 CLARENDON CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-1644
Practice Address - Country:US
Practice Address - Phone:239-287-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral