Provider Demographics
NPI:1871654251
Name:VLACH, AMY CAROLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CAROLE
Last Name:VLACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 DEER RUN S
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-6500
Mailing Address - Country:US
Mailing Address - Phone:662-236-6696
Mailing Address - Fax:662-236-4176
Practice Address - Street 1:510 AZALEA DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-8114
Practice Address - Country:US
Practice Address - Phone:662-236-6696
Practice Address - Fax:662-236-9146
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional