Provider Demographics
NPI:1750383410
Name:NEVISON, AMY S (LPCC-S)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
Last Name:NEVISON
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DIANE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1940
Mailing Address - Country:US
Mailing Address - Phone:419-668-0528
Mailing Address - Fax:419-663-5643
Practice Address - Street 1:333 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1940
Practice Address - Country:US
Practice Address - Phone:419-668-0528
Practice Address - Fax:419-663-5643
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003025-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
340243OtherTRICARE MENTAL HEALTH NET
OH000000367948OtherANTHEM BLUE CROSS
220157000OtherMAGELLAN
521836OtherVALUE OPTIONS