Provider Demographics
NPI:1891945150
Name:PICO, AMY (LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PICO
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 1:704 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7311
Mailing Address - Country:US
Mailing Address - Phone:217-840-6992
Mailing Address - Fax:877-480-8915
Practice Address - Street 1:704 DEVONSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7311
Practice Address - Country:US
Practice Address - Phone:217-840-6992
Practice Address - Fax:877-480-8915
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional