Provider Demographics
NPI:1881145779
Name:HAM, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-1328
Mailing Address - Country:US
Mailing Address - Phone:701-751-1545
Mailing Address - Fax:701-751-1635
Practice Address - Street 1:368 E. MAIN ST STE 1
Practice Address - Street 2:#1328
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-1328
Practice Address - Country:US
Practice Address - Phone:701-751-1545
Practice Address - Fax:701-751-1365
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND890-10-15-16A101YM0800X
ND890-10-15-16-361101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health