MEDICARE: MRS. AMY LYNN BOTTOMLY LPC

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	101YM0800X	Mental Health Counselor	6362	OK

General Provider Information

NPI Number	:	1922302777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNN BOTTOMLY LPC

Provider Business Mailing Address
First Line	:	4824 GREEN COUNTRY RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-0900
Country	:	US
Telephone Number	:	405-361-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	9212 N KELLEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-2419
Country	:	US
Telephone Number	:	405-242-5070
Fax Number	:

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

Provider Enumeration Date	:	01/07/2011
Last Update Date	:	03/04/2022

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