Healthcare Provider Details

I. General information

NPI: 1518668813
Provider Name (Legal Business Name): AMANDA JOY NAYBACK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 ANITA LN
EATON RAPIDS MI
48827-9216
US

IV. Provider business mailing address

1864 ANITA LN
EATON RAPIDS MI
48827-9216
US

V. Phone/Fax

Practice location:
  • Phone: 517-410-1398
  • Fax:
Mailing address:
  • Phone: 517-410-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401226460
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: