MEDICARE: AMY BRICKLER

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1699382820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMY BRICKLER

Provider Business Mailing Address
First Line	:	1721 US 31W BYP
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-3030
Country	:	US
Telephone Number	:	270-843-1804
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 US 31W BYP
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-3030
Country	:	US
Telephone Number	:	270-843-1804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY BRICKLER
Credential	:	LPCC
Telephone Number	:	478-397-7658

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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