Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1144896911 |
---|---|
Provider Name | Ms. Ashley Anne Amos |
First Address | Bellevue, OH 44811-1011 |
Second Address | Bellevue, OH 44811-1011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103903620-00 | (05) | OH |