Provider Demographics
NPI:1730259946
Name:STRANGE, AMY WILSON (PHD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:WILSON
Last Name:STRANGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:107 SOUTH STREETCAR WAY
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-0490
Mailing Address - Country:US
Mailing Address - Phone:304-745-5065
Mailing Address - Fax:304-745-5067
Practice Address - Street 1:107 SOUTH STREETCAR WAY
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385-0490
Practice Address - Country:US
Practice Address - Phone:304-745-5065
Practice Address - Fax:304-745-5067
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV858103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9205097001Medicaid
WVSTCP31162Medicare ID - Type Unspecified