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General NPI Number Information
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NPI Number | 1992061501
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Entity Type | Organization
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Legal Business Name | MICHELE AMBURGEY M A CERTIFIED PSYCHOLOGIST PSC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 84 E MAIN ST SUITE A
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City | WHITESBURG
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State | KY
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Zip | 41858-7254
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Country | US
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Telephone | 606-633-0035
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Fax | 606-633-0035
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Provider Business Mailing Address
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Address Line | PO BOX 538
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City | WHITESBURG
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State | KY
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Zip | 41858-0538
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Country | US
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Telephone | 606-633-0035
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Fax | 606-633-0035
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | MICHELE AMBURGEY
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Credential | M.A.
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Telephone | 606-633-0035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0148
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License Number State | KY
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