Provider Demographics
NPI:1871620393
Name:AMIS, WILLIAM P (MS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:AMIS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRANT VALKARIA
Mailing Address - State:FL
Mailing Address - Zip Code:32949-5326
Mailing Address - Country:US
Mailing Address - Phone:772-321-6454
Mailing Address - Fax:
Practice Address - Street 1:2814 S US HIGHWAY 1
Practice Address - Street 2:SUITE D4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8120
Practice Address - Country:US
Practice Address - Phone:772-489-4726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health