=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164047205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY ELIZABETH CHOULAT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2020
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 S 3RD ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43055-5335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-345-6874
-----------------------------------------------------
Fax | 740-345-5157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 327 UNION ST APT J22
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43055-8027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-624-8073
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S.2512469
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------