Healthcare Provider Details

I. General information

NPI: 1609364595
Provider Name (Legal Business Name): AMY M LILLYWHITE LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY M DOYLE

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD STE 311
LANSING MI
48910-6825
US

IV. Provider business mailing address

7760 S M 52
OWOSSO MI
48867-9265
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8200
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-285-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802090176
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: