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NPI Code Detail

MEDICARE: OPEN FIELDS MENTAL HEALTH, PLLC

MEDICARE: OPEN FIELDS MENTAL HEALTH, PLLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1861285470
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPEN FIELDS MENTAL HEALTH, PLLC
Provider Business Mailing Address
First Line : 510 FRANKLIN CT
Second Line :
City : DUNDEE
State : MI
Zip : 48131-1200
Country : US
Telephone Number : 313-333-7869
Fax Number :
Provider Business Practice Location Address
First Line : 415 MILL RD BLDG A
Second Line :
City : ADRIAN
State : MI
Zip : 49221-1764
Country : US
Telephone Number : 313-333-7869
Fax Number :
Authorized Official
Title or Position : OWNER
Name : AMANDA JOY DUFTY
Credential : LCSW
Telephone Number : 734-215-5089
Provider Enumeration Date : 05/27/2025
Last Update Date : 09/04/2025

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