Amy J Dunham, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E-3478 Issued in OH

Practice address

5350 Lamme Rd
Moraine, OH 45439-3215

Phone

(937) 534-4600

Fax

(937) 522-8788

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Amy J Licata Other name

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• New Creation Counseling Center

  • Counselor
  • Tipp City, OH
  • NPI 1427461763
  NPD (past)
• New Creation Counseling Inc

  • Voluntary or Charitable Agency
  • Tipp City, OH
  • NPI 1134295439
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672272000000",
    "number": "1578788642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PRESTIGE PL STE 550",
            "city": "MIAMISBURG",
            "state": "OH",
            "postal_code": "453426115",
            "telephone_number": "937-762-1310",
            "fax_number": "937-522-8068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 LAMME RD",
            "city": "MORAINE",
            "state": "OH",
            "postal_code": "454393215",
            "telephone_number": "937-534-4600",
            "fax_number": "937-522-8788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7695 S. County Rd. 25A",
            "address_purpose": "LOCATION",
            "city": "Tipp City",
            "state": "OH",
            "postal_code": "453719215",
            "country_code": "US",
            "telephone_number": "937-667-4678",
            "fax_number": "937-667-4963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUNHAM",
        "first_name": "AMY",
        "middle_name": "J",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2022-12-29",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E-3478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "adunham11385@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "5350 Lamme Rd",
            "city": "Moraine",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454393215",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "5350 Lamme Rd",
            "city": "Moraine",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454393215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "LICATA",
            "middle_name": "J",
            "credential": "LPCC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jodi Dozier
• Paula Evangeline Drake
• Tonica Dudley
• Otto R. Dueno, M.D.
• Jarhal Duncan
• Lee Richard Dunham, LISW-S
• Kristina M Dunlevy
• Michael Durham
• Lauren Durnwald
• Marah Suzanne Eagy

• Mental Health Counselor in Moraine, OH
• Providers in Moraine, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.