Amy Marie O'Bryan, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

11654 Issued in NC

Practice address

1020 Crews Rd Ste M
Matthews, NC 28105-7587

Phone

(704) 807-6555

NPI assigned

Nov 11, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Charlotte Family Counseling

  • Professional Counselor
  • Matthews, NC
  • NPI 1013395300

  Professional

  NPD (past)

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573430400000",
    "number": "1508401837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 WALNUT POINT DR",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281051559",
            "telephone_number": "404-786-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 CREWS RD STE M",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281057587",
            "telephone_number": "704-807-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRYAN",
        "first_name": "AMY",
        "middle_name": "MARIE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2019-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "11654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC",
            "identifier": "11654",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.southcharlottefamilycounseling.com",
            "affiliation": "N",
            "endpointDescription": "Counseling office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1020 Crews Rd Ste M",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281057587",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.southcharlottefamilycounseling.com",
            "affiliation": "N",
            "endpointDescription": "Counseling office",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1020 Crews Rd Ste M",
            "city": "Matthews",
            "state": "NC",
            "country_code": "US",
            "postal_code": "281057587",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Matthews, NC
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2019; 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.