Provider Demographics
NPI:1023659679
Name:ABBASOV, AMY (MED LPC-S)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:ABBASOV
Suffix:
Gender:F
Credentials:MED LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BESEMER LN
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9699
Mailing Address - Country:US
Mailing Address - Phone:806-236-4156
Mailing Address - Fax:
Practice Address - Street 1:23 BESEMER LN
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-9699
Practice Address - Country:US
Practice Address - Phone:806-236-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX65000OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS