Provider Demographics
NPI:1881218642
Name:HOOTMAN, AMY LYNN (LMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:HOOTMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN POOLE
Other - Last Name:HOOTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:2806 W FAWKESWAY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1211
Mailing Address - Country:US
Mailing Address - Phone:812-719-3224
Mailing Address - Fax:
Practice Address - Street 1:2806 W FAWKESWAY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-1211
Practice Address - Country:US
Practice Address - Phone:812-719-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001875A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health