Healthcare Provider Details

I. General information

NPI: 1467099622
Provider Name (Legal Business Name): AMG COUNSELING, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 LONGBROOK DR
MACEDONIA OH
44056-1665
US

IV. Provider business mailing address

8945 LONGBROOK DR
MACEDONIA OH
44056-1665
US

V. Phone/Fax

Practice location:
  • Phone: 216-276-5628
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMY GLANDER
Title or Position: CEO
Credential:
Phone: 216-276-5628