Individual
AMI FORMICA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPCA
Contact information
Practice address
497 SW CENTURY DR STE 102, BEND, OR 97702-1167
(201) 233-0293
Mailing address
497 SW CENTURY DR STE 102, BEND, OR 97702-1167
(201) 233-0293
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
R9764
OR
Other
Enumeration date
07/29/2026
Last updated
07/29/2026
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