Provider Demographics
NPI:1225455017
Name:CHERIAN, AMANDA MARIE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:CHERIAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4785 YELLOW PINE LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-3761
Mailing Address - Country:US
Mailing Address - Phone:269-303-0463
Mailing Address - Fax:
Practice Address - Street 1:3030 S 9TH ST
Practice Address - Street 2:STE 3E
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-7956
Practice Address - Country:US
Practice Address - Phone:269-544-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional