MEDICARE: AMY R COLLIER LCSW, LCAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	87000593A	IN
2	1041C0700X	Clinical Social Worker	34006165A	IN

General Provider Information

NPI Number	:	1205114857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY R COLLIER LCSW, LCAC

Provider Business Mailing Address
First Line	:	2702 GLENDALE BLVD
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-3982
Country	:	US
Telephone Number	:	219-386-3320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 GLENDALE BLVD
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-3982
Country	:	US
Telephone Number	:	219-386-3320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	02/07/2025

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