=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770476558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY DEAL AMES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2025
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29532 SOUTHFIELD RD
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-985-7328
-----------------------------------------------------
Fax | 248-800-7265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18530 MACK AVE UNIT 299
-----------------------------------------------------
City | GROSSE POINTE FARMS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48236-3254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMY AMES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-985-7328
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------