Healthcare Provider Details

I. General information

NPI: 1043984685
Provider Name (Legal Business Name): AMY LYNN WHITNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 S 5TH AVE
CLARION PA
16214-6010
US

IV. Provider business mailing address

342 S 5TH AVE
CLARION PA
16214-6010
US

V. Phone/Fax

Practice location:
  • Phone: 814-226-4913
  • Fax: 814-226-4914
Mailing address:
  • Phone: 814-226-4913
  • Fax: 814-226-4914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013489
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: