Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Clinical |
1041C0700X | 80 | Licensed Clinical Social Worker |
| NPI Number | 1972862175 |
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| LBN Legal business name | AMY LYNN WELLNESS, LLC | ||||||||
| Authorized official | AMY LYNN - (PRESIDENT & CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/08/2012 | ||||||||
| Last updated | 05/08/2012 - About 14 years ago | ||||||||
| Identifiers |
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