Healthcare Provider Details

I. General information

NPI: 1801226212
Provider Name (Legal Business Name): AMY ANDERSON MA, LPC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-8250
US

IV. Provider business mailing address

789 N CLARE AVE
HARRISON MI
48625-8250
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax: 989-539-2143
Mailing address:
  • Phone: 989-539-2141
  • Fax: 989-539-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401007700
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: