Provider Demographics
NPI:1053625822
Name:WILTER, AMY ALGER (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:ALGER
Last Name:WILTER
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 194TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9203
Mailing Address - Country:US
Mailing Address - Phone:206-613-9057
Mailing Address - Fax:
Practice Address - Street 1:608 194TH PL SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-9203
Practice Address - Country:US
Practice Address - Phone:206-613-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60159459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health