| Amy Bottomly Llc | |
|
3233 E Memorial Rd Edmond OK 73013-7082 | |
| (405) 361-9599 | |
| (405) 703-0645 |
| Full Name | Amy Bottomly Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3233 E Memorial Rd, Edmond, Oklahoma |
| Authorized Official Name and Position | Amy Bottomly (OWNER) |
| Authorized Official Contact | 4053619599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amy Bottomly Llc 4824 Green Country Rd Edmond OK 73034-0900 Ph: () - | Amy Bottomly Llc 3233 E Memorial Rd Edmond OK 73013-7082 Ph: (405) 361-9599 |
| NPI Number | 1710798681 |
|---|---|
| Provider Enumeration Date | 01/18/2025 |
| Last Update Date | 01/18/2025 |
| Certification Date | 01/18/2025 |
| Medicare PECOS PAC ID | 7517496896 |
|---|---|
| Medicare Enrollment ID | O20250131000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710798681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Amy L Bottomly |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922302777 PECOS PAC ID: 2860838182 Enrollment ID: I20240308002908 |
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