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General NPI Number Information
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NPI Number | 1154216828
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Entity Type | Individual
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Provider Name | AMY MARIE BACON LAPC
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 4380 W 12TH ST STE 2F
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City | ERIE
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State | PA
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Zip | 16505-3028
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Country | US
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Telephone | 814-580-6166
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Fax |
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Provider Business Mailing Address
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Address Line | 238 WILCOX ST
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City | GIRARD
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State | PA
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Zip | 16417-1340
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Country | US
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Telephone | 814-218-5194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC001309
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License Number State | PA
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