Provider Demographics
NPI:1285357087
Name:SCHALLER, AMY BETH (BA,LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:SCHALLER
Suffix:
Gender:F
Credentials:BA,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 MILL SPGS
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:IN
Mailing Address - Zip Code:46128-9386
Mailing Address - Country:US
Mailing Address - Phone:765-775-6687
Mailing Address - Fax:
Practice Address - Street 1:101 SUZIE LN STE 6
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:IN
Practice Address - Zip Code:47918-2000
Practice Address - Country:US
Practice Address - Phone:765-775-6687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty