Provider Demographics
NPI:1124516604
Name:INNIS, AMELIA (MFT)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:INNIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 NEW GULPH RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1617
Mailing Address - Country:US
Mailing Address - Phone:610-348-7743
Mailing Address - Fax:
Practice Address - Street 1:222 N WALNUT ST STE E
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2608
Practice Address - Country:US
Practice Address - Phone:610-348-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist