Healthcare Provider Details

I. General information

NPI: 1144773813
Provider Name (Legal Business Name): AMY MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY STEWART MA, LPC

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 S RIPLEY BLVD
ALPENA MI
49707-3406
US

IV. Provider business mailing address

154 S RIPLEY BLVD
ALPENA MI
49707-3406
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-6385
  • Fax:
Mailing address:
  • Phone: 989-356-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401002428
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: