Provider Demographics
NPI:1245652601
Name:FOLSOM, AMY KATHRYN (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHRYN
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-6201
Mailing Address - Country:US
Mailing Address - Phone:989-274-8891
Mailing Address - Fax:989-393-2012
Practice Address - Street 1:110 S AUBURN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MI
Practice Address - Zip Code:48611-9366
Practice Address - Country:US
Practice Address - Phone:989-545-1358
Practice Address - Fax:989-393-2012
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007414101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional