Provider Demographics
NPI:1215549233
Name:AMIN, AMELIA (PHD, LP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 STANFORD RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-3059
Mailing Address - Country:US
Mailing Address - Phone:248-591-0891
Mailing Address - Fax:
Practice Address - Street 1:2855 COOLIDGE HWY STE 101
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3215
Practice Address - Country:US
Practice Address - Phone:248-649-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011610103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical