Provider Demographics
NPI:1104584929
Name:GAMMILL, AMON BAILEY (LPC)
Entity type:Individual
Prefix:
First Name:AMON
Middle Name:BAILEY
Last Name:GAMMILL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3377 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4088
Mailing Address - Country:US
Mailing Address - Phone:972-358-3416
Mailing Address - Fax:
Practice Address - Street 1:206 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3560
Practice Address - Country:US
Practice Address - Phone:256-341-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health