Provider Demographics
NPI:1255788311
Name:HALTER, AMY (MA, MED, NCC, LPC,)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:HALTER
Suffix:
Gender:F
Credentials:MA, MED, NCC, LPC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:VANDERGRIFT
Mailing Address - State:PA
Mailing Address - Zip Code:15690-1165
Mailing Address - Country:US
Mailing Address - Phone:724-787-9090
Mailing Address - Fax:
Practice Address - Street 1:560 BEATTY RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-1334
Practice Address - Country:US
Practice Address - Phone:412-374-8275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008961101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional