Provider Demographics
NPI:1003141359
Name:PUGH, AMY E (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:E
Last Name:PUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 MICHIGAN ST NE STE 5201
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2514
Practice Address - Country:US
Practice Address - Phone:616-267-2830
Practice Address - Fax:616-267-9024
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent