Healthcare Provider Details

I. General information

NPI: 1649736471
Provider Name (Legal Business Name): AMBER KNAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 W 25TH ST
HOLLAND MI
49423-4574
US

IV. Provider business mailing address

843 W 25TH ST
HOLLAND MI
49423-4574
US

V. Phone/Fax

Practice location:
  • Phone: 269-779-6139
  • Fax:
Mailing address:
  • Phone: 269-779-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024049
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: