Provider Demographics
NPI:1972007037
Name:ALLETZHAUSER, AMY L (DMIN LPP)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:ALLETZHAUSER
Suffix:
Gender:F
Credentials:DMIN LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ERMER RD UNIT 215
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1273
Mailing Address - Country:US
Mailing Address - Phone:603-890-6767
Mailing Address - Fax:603-893-6767
Practice Address - Street 1:15 ERMER RD UNIT 215
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1273
Practice Address - Country:US
Practice Address - Phone:603-890-6767
Practice Address - Fax:603-893-6767
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH68101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral