Amy Theodor, MS, LPCC-S, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

E.0900110-SUPV Issued in OH

Practice address

4266 Fowler Dr
Bellbrook, OH 45305-1171

Phone

(937) 823-0177

NPI assigned

Nov 16, 2016

Last updated

Feb 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Interoperability endpoints

• Direct secure messaging: kellys@innersightcounseling.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676419200000",
    "number": "1285176685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4266 FOWLER DR",
            "city": "BELLBROOK",
            "state": "OH",
            "postal_code": "453051171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4266 FOWLER DR",
            "city": "BELLBROOK",
            "state": "OH",
            "postal_code": "453051171",
            "telephone_number": "937-823-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODOR",
        "first_name": "AMY",
        "credential": "MS, LPCC-S, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-16",
        "last_updated": "2023-02-15",
        "certification_date": "2023-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "OH",
            "license": "E.0900110-SUPV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kellys@innersightcounseling.com",
            "affiliation": "N",
            "endpointDescription": "practice email",
            "address_1": "3171 Beaver Vu Dr Ste C",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454346368",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Professional Counselor in Bellbrook, OH
• Providers in Bellbrook, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.