Provider Demographics
NPI:1154747699
Name:OTZEL, AMY BETH (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:OTZEL
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 THE LAKES BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-5667
Mailing Address - Country:US
Mailing Address - Phone:904-310-4325
Mailing Address - Fax:904-895-6057
Practice Address - Street 1:140 THE LAKES BLVD STE 225
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-5667
Practice Address - Country:US
Practice Address - Phone:904-310-4325
Practice Address - Fax:904-895-6057
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19274101YM0800X
CT002098101YP2500X
GALPC013174101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health