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General NPI Number Information
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NPI Number | 1720616766
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Entity Type | Organization
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Legal Business Name | AMANDA ESTILL LLC
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 119 W CASS ST UNIT 91
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City | GREENVILLE
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State | MI
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Zip | 48838-5003
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Country | US
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Telephone | 989-506-4457
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Fax | 616-619-6007
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Provider Business Mailing Address
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Address Line | 119 W CASS ST UNIT 91
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City | GREENVILLE
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State | MI
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Zip | 48838-5003
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Country | US
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Telephone | 989-506-4457
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Fax | 616-619-6007
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | AMANDA ESTILL
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Credential | LPC
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Telephone | 989-506-4457
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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 |
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License Number State |
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