Provider Demographics
NPI:1316638513
Name:WORMLEY, SHILOH AMANDA (LMHC)
Entity type:Individual
Prefix:
First Name:SHILOH
Middle Name:AMANDA
Last Name:WORMLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SHILOH
Other - Middle Name:AMANDA
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1932 FORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:NY
Mailing Address - Zip Code:14532-9768
Mailing Address - Country:US
Mailing Address - Phone:315-521-4505
Mailing Address - Fax:
Practice Address - Street 1:1932 FORT HILL RD
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:NY
Practice Address - Zip Code:14532-9768
Practice Address - Country:US
Practice Address - Phone:315-521-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006441-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health