MEDICARE: AMANDA LEIGH HENRY LLPC

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	101Y00000X	Counselor	6451023066	MI
2	101YP2500X	Professional Counselor	6451023066	MI

General Provider Information

NPI Number	:	1992573539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LEIGH HENRY LLPC

Provider Business Mailing Address
First Line	:	204 E CHURCH ST STE 100
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-2953
Country	:	US
Telephone Number	:	734-265-0043
Fax Number	:	855-923-0905

Provider Business Practice Location Address
First Line	:	204 E CHURCH ST STE 100
Second Line	:
City	:	ADRIAN
State	:	MI
Zip	:	49221-2953
Country	:	US
Telephone Number	:	734-265-0043
Fax Number	:	855-923-0905

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

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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