Healthcare Provider Details

I. General information

NPI: 1144606344
Provider Name (Legal Business Name): AMANDA MAY SZUBELAK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAVIS MAY MEYER LLP

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 GARDEN AVENUE
HOLLAND MI
49424
US

IV. Provider business mailing address

4108 MEYER DR
HAMILTON MI
49419-9205
US

V. Phone/Fax

Practice location:
  • Phone: 616-834-1264
  • Fax:
Mailing address:
  • Phone: 616-834-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401019078
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301016402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: