Provider Demographics
NPI:1467665638
Name:STILES-BODNAR, AMBER LYN (MSED, LPCC, LCDC III)
Entity type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LYN
Last Name:STILES-BODNAR
Suffix:
Gender:F
Credentials:MSED, LPCC, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 STATE ROUTE 5 STE B
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9201
Mailing Address - Country:US
Mailing Address - Phone:330-282-4301
Mailing Address - Fax:330-282-4306
Practice Address - Street 1:2996 STATE ROUTE 5 STE B
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9201
Practice Address - Country:US
Practice Address - Phone:330-282-4301
Practice Address - Fax:330-282-4306
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0501059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional