Healthcare Provider Details

I. General information

NPI: 1104439355
Provider Name (Legal Business Name): JASON AMYX LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

858 5TH AVE SE
CALVERT CITY KY
42029
US

IV. Provider business mailing address

956 FAIRVIEW ST
BENTON KY
42025-7360
US

V. Phone/Fax

Practice location:
  • Phone: 270-559-8247
  • Fax:
Mailing address:
  • Phone: 270-559-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number245735
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: