Provider Demographics
NPI:1962542688
Name:MOOREHEAD, AMY N (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:N
Last Name:MOOREHEAD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:NICI
Other - Middle Name:
Other - Last Name:MOOREHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:106 FORDWICK LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1417
Mailing Address - Country:US
Mailing Address - Phone:219-531-1013
Mailing Address - Fax:
Practice Address - Street 1:8091 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-7068
Practice Address - Country:US
Practice Address - Phone:219-942-5590
Practice Address - Fax:815-301-8797
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health