Healthcare Provider Details

I. General information

NPI: 1760879571
Provider Name (Legal Business Name): AMANDA LYNN MCLAIN BARRATT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6818
US

IV. Provider business mailing address

3753 WILLIAMSTON RD
LESLIE MI
49251-9323
US

V. Phone/Fax

Practice location:
  • Phone: 517-897-5248
  • Fax:
Mailing address:
  • Phone: 517-990-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801097634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: