Individual
AMY S BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ED, LPC
Contact information
Practice address
474 N YELLOW SPRINGS ST, SPRINGFIELD, OH 45504-2463
(937) 399-9500
Mailing address
474 N YELLOW SPRINGS ST, SPRINGFIELD, OH 45504-2463
(937) 399-9500
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
E.19800825-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0066745
—
OH
Enumeration date
07/09/2013
Last updated
08/12/2024
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