Provider Demographics
NPI:1861691107
Name:BALCAM, AMY AILEEN (MA, EDS LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:AILEEN
Last Name:BALCAM
Suffix:
Gender:F
Credentials:MA, EDS LMHC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:AILEEN
Other - Last Name:BARTLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,EDS, LMHC
Mailing Address - Street 1:620 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-0323
Mailing Address - Country:US
Mailing Address - Phone:812-231-8438
Mailing Address - Fax:812-231-8191
Practice Address - Street 1:1000 COUNTY ROAD WEST LONETREE
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441
Practice Address - Country:US
Practice Address - Phone:812-847-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001360A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN119674444OtherCAQH