Provider Demographics
NPI:1922595495
Name:BRAGG, AMY LYNN (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2200
Mailing Address - Country:US
Mailing Address - Phone:304-523-9673
Mailing Address - Fax:304-523-9674
Practice Address - Street 1:401 10TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2200
Practice Address - Country:US
Practice Address - Phone:304-523-9673
Practice Address - Fax:304-523-9674
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health