Provider Demographics
NPI:1891460366
Name:FANTOZZI, AMY (LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FANTOZZI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 SWEDE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-7669
Mailing Address - Country:US
Mailing Address - Phone:406-283-1350
Mailing Address - Fax:
Practice Address - Street 1:216 W 9TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1866
Practice Address - Country:US
Practice Address - Phone:406-291-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-57447101YP2500X
MTBBH-PCLC-LIC-48122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional