Tanya M Amos, MS, LPC
Individual provider Active NPI Professional Counselor · Wautoma, WI
NPI 1265714455 · NPPES record last updated Jan 16, 2015
Key facts
- NPI
- 1265714455
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 4648-125 (WI)
- Practice address
- 230 W Park Street
Wautoma, WI 54982-9031 - Phone
- (920) 787-6550
- Fax
- (920) 787-0421
- NPI assigned
- Sep 13, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4648-125 | WI | MD | Professional Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 4648-125 | WI | Yes |
Addresses
Primary practice location
230 W Park Street
Wautoma, WI 54982-9031
Mailing address
PO Box 1230
Wautoma, WI 54982-1230
Phone (920) 787-6550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265714455 | Medicaid | WI |
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All providers in Wautoma, WI · Professional Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.