MEDICARE: MS. AMIRA DOUCETTE LPC, LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	6301011404	MI
2	101Y00000X	Counselor	6401007666	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P108916200	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1225242431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMIRA DOUCETTE LPC, LLP

Provider Business Mailing Address
First Line	:	6421 ALDEN DR
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324-2003
Country	:	US
Telephone Number	:	248-933-9329
Fax Number	:	248-624-7901

Provider Business Practice Location Address
First Line	:	6421 ALDEN DR
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324-2003
Country	:	US
Telephone Number	:	248-933-9329
Fax Number	:	248-624-7901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/11/2024

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