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General NPI Number Information
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NPI Number | 1588017461
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Entity Type | Organization
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Legal Business Name | AMBERSOURCE, PLLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 07/06/2017
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Provider Practice Location Address
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Address Line | 60 DIVISION ST STE B
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City | MANISTEE
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State | MI
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Zip | 49660-2720
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Country | US
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Telephone | 989-529-3964
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Fax | 231-723-5879
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Provider Business Mailing Address
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Address Line | 60 DIVISION ST STE B
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City | MANISTEE
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State | MI
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Zip | 49660-2720
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Country | US
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Telephone | 989-529-3964
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Fax | 231-723-5870
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. LAURA JANE C. MURPHY
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Credential | PSY.D.
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Telephone | 989-529-3964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301014966
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License Number State | MI
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