Provider Demographics
NPI:1841720489
Name:AMY AMIDON PHD, PLLC
Entity type:Organization
Organization Name:AMY AMIDON PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:AMIDON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-846-3625
Mailing Address - Street 1:3825 LADUKE ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6126
Mailing Address - Country:US
Mailing Address - Phone:619-846-3625
Mailing Address - Fax:
Practice Address - Street 1:1648 ELLIS ST STE 302
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8811
Practice Address - Country:US
Practice Address - Phone:619-846-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2081261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health