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General NPI Number Information
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NPI Number | 1386705077
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Entity Type | Individual
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Provider Name | AMY SUE THATCHER LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 5319 PAYLOR LN STE 100
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34240-2207
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Country | US
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Telephone | 941-587-2055
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Fax | 941-499-0404
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Provider Business Mailing Address
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Address Line | 2492 S MACAFEE RD
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City | SAYRE
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State | PA
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Zip | 18840-7821
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Country | US
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Telephone | 941-587-2055
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Fax | 941-499-0404
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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 | SW8459
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License Number State | FL
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