Healthcare Provider Details

I. General information

NPI: 1467845271
Provider Name (Legal Business Name): AMANDA KAY WALTERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24715 LITTLE MACK AVE STE 200
SAINT CLAIR SHORES MI
48080-3207
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0784
  • Fax: 586-777-0823
Mailing address:
  • Phone: 517-492-0784
  • Fax: 586-777-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014761
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: