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General NPI Number Information
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NPI Number | 1912767500
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Entity Type | Individual
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Provider Name | AMY FORT
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1833 S MILLENIUM WAY # 120
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City | MERIDIAN
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State | ID
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Zip | 83642-1510
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Country | US
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Telephone | 208-343-7797
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Fax |
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Provider Business Mailing Address
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Address Line | 14886 MASTERS DR
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City | CALDWELL
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State | ID
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Zip | 83607-7693
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Country | US
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Telephone | 208-684-0008
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFTI-9413
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 8341154
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License Number State | ID
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