Provider Demographics
NPI:1679905954
Name:SPELL, AMY (MA, CTA, CTS, LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:
Last Name:SPELL
Suffix:
Gender:F
Credentials:MA, CTA, CTS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 KILBOURNE ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9431
Mailing Address - Country:US
Mailing Address - Phone:419-217-0516
Mailing Address - Fax:
Practice Address - Street 1:817 KILBOURNE ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9431
Practice Address - Country:US
Practice Address - Phone:419-217-0516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1200239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health