Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2011-100 | KY |
NPI | 1083965206 |
---|---|
Provider Name | Amy Lynn Fowkes |
First Address | Louisville, KY 40241-1299 |
Second Address | Crestwood, KY 40014-7418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2012 |
Last Update Date | 27/09/2012 |