Provider Demographics
NPI:1417185554
Name:SAXE, AMANDA REBECCA (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:REBECCA
Last Name:SAXE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5745 W. MAPLE RD SUITE 213
Mailing Address - Street 2:
Mailing Address - City:W. BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:810-623-3261
Mailing Address - Fax:844-893-1355
Practice Address - Street 1:5745 W. MAPLE RD SUITE 213
Practice Address - Street 2:
Practice Address - City:W. BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:810-623-3261
Practice Address - Fax:844-893-1355
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1999026101YP2500X
MI6401011386101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI101YM0800XMedicaid