Provider Demographics
NPI:1356839682
Name:NUNGESTER, AMY JEANNE (LICDC, LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JEANNE
Last Name:NUNGESTER
Suffix:
Gender:F
Credentials:LICDC, LPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JEANNE
Other - Last Name:SEIDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICDC, LPC
Mailing Address - Street 1:2065 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-8956
Mailing Address - Country:US
Mailing Address - Phone:740-500-1391
Mailing Address - Fax:
Practice Address - Street 1:2065 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-8956
Practice Address - Country:US
Practice Address - Phone:740-500-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2305598101YM0800X
OHLICDC.162495101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health