1497116875 NPI number — AMY VITACOLONNA MS

Table of content: AMY VITACOLONNA MS (NPI 1497116875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497116875 NPI number — AMY VITACOLONNA MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITACOLONNA
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYRFIELD
Provider Other First Name:
AMY
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497116875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANGLETON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77516-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-349-8775
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 INDIAN WARRIOR TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE JACKSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77566-3253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-349-8775
Provider Business Practice Location Address Fax Number:
843-897-0100
Provider Enumeration Date:
03/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LH60943631 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LH60943631 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8246 . This is a "SOUTH CAROLINA LICENSING BOARD FOR COUNSELORS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 85-2743925 . This is a "IRS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 95893 . This is a "TEXAS BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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