Provider Demographics
NPI:1770713778
Name:WILLCOXON, AMY B (PSYD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:WILLCOXON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4816
Mailing Address - Country:US
Mailing Address - Phone:406-407-6914
Mailing Address - Fax:
Practice Address - Street 1:1077 WHITEFISH STAGE
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2735
Practice Address - Country:US
Practice Address - Phone:406-249-0824
Practice Address - Fax:406-890-6817
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4031103TC0700X
MT1478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical