Provider Demographics
NPI:1316345952
Name:HOMER, AMY (LPCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HOMER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 PAVILION PKWY # 132
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2891
Mailing Address - Country:US
Mailing Address - Phone:859-630-2336
Mailing Address - Fax:
Practice Address - Street 1:20 N GRAND AVE STE 110D
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4106
Practice Address - Country:US
Practice Address - Phone:859-630-2336
Practice Address - Fax:513-828-0250
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1100627101YP2500X
KYLPCPCC00222201101YP2500X
KY165583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional