MEDICARE: AMENA RATHUR LLMSW

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	101YM0800X	Mental Health Counselor	6802083176	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	897096	OTHER	MI	BCBS PIN

General Provider Information

NPI Number	:	1639102189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMENA RATHUR LLMSW

Provider Business Mailing Address
First Line	:	2122 15 MILE RD
Second Line	:	SUITE B
City	:	STERLING HTS
State	:	MI
Zip	:	48310-4853
Country	:	US
Telephone Number	:	586-264-3692
Fax Number	:	586-939-5953

Provider Business Practice Location Address
First Line	:	2122 15 MILE RD
Second Line	:	SUITE B
City	:	STERLING HTS
State	:	MI
Zip	:	48310-4853
Country	:	US
Telephone Number	:	586-264-3692
Fax Number	:	586-939-5953

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	07/08/2007

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