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General NPI Number Information
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NPI Number | 1023453040
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Entity Type | Individual
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Provider Name | AMY REBECCA BROCKSCHMIDT LLPC
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Gender | Female
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Dates
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Enumeration Date | 05/03/2013
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | TEN16 RECOVERY NETWORK 1302 CHATTERTON ST. 2
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City | GLADWIN
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State | MI
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Zip | 48624
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Country | US
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Telephone | 989-426-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 E PARIS AVE SE ST. 203
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2426
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Country | US
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Telephone | 616-929-0226
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401013612
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License Number State | MI
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