Provider Demographics
NPI:1144606344
Name:SZUBELAK, AMANDA MAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MAY
Last Name:SZUBELAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:MAY
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLP
Mailing Address - Street 1:4108 MEYER DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-9205
Mailing Address - Country:US
Mailing Address - Phone:616-834-1264
Mailing Address - Fax:
Practice Address - Street 1:393 GARDEN AVENUE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-834-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016402103TC1900X
MI6401019078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling