MEDICARE: JILL AMICO, MA, LPC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457874281	OTHER		TYPE 1 NPI

General Provider Information

NPI Number	:	1639886385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JILL AMICO, MA, LPC

Provider Business Mailing Address
First Line	:	805 OAKWOOD DR STE 210
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1359
Country	:	US
Telephone Number	:	248-495-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 OAKWOOD DR STE 210
Second Line	:
City	:	ROCHESTER
State	:	MI
Zip	:	48307-1359
Country	:	US
Telephone Number	:	248-495-0977
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR/OWNER
Name	:	JILL AMICO
Credential	:	MA, LPC
Telephone Number	:	248-495-0977

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	05/06/2024

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