Provider Demographics
NPI:1417794223
Name:KOONTZ, AMIE (CMHC)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 GIBOU RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05471-2032
Mailing Address - Country:US
Mailing Address - Phone:802-760-0715
Mailing Address - Fax:
Practice Address - Street 1:1788 GIBOU RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CENTER
Practice Address - State:VT
Practice Address - Zip Code:05471-2032
Practice Address - Country:US
Practice Address - Phone:802-760-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135962101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health