Healthcare Provider Details

I. General information

NPI: 1356717052
Provider Name (Legal Business Name): AMANDA BERES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38746 COVINGTON DR
STERLING HEIGHTS MI
48312-1312
US

IV. Provider business mailing address

38746 COVINGTON DR
STERLING HEIGHTS MI
48312-1312
US

V. Phone/Fax

Practice location:
  • Phone: 586-214-7223
  • Fax:
Mailing address:
  • Phone: 586-214-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-15-01459
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224381
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: