Provider Demographics
NPI:1386150027
Name:ETTINGER, AMY DAWN (PLPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DAWN
Last Name:ETTINGER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CHRISTIAN LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1377
Mailing Address - Country:US
Mailing Address - Phone:985-781-7353
Mailing Address - Fax:985-781-7354
Practice Address - Street 1:113 CHRISTIAN LN
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-1377
Practice Address - Country:US
Practice Address - Phone:985-781-7353
Practice Address - Fax:985-781-7354
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6954101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor