Healthcare Provider Details

I. General information

NPI: 1720964810
Provider Name (Legal Business Name): AMBER N THOMPSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 302
GRAND RAPIDS MI
49525-9350
US

IV. Provider business mailing address

7 CLEARWATER CT
STREAMWOOD IL
60107-2310
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-6522
  • Fax:
Mailing address:
  • Phone: 331-200-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024541
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: