Provider Demographics
NPI:1487639654
Name:MACEY, AMY KATHRYN (PHD, LPC, SCL)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:KATHRYN
Last Name:MACEY
Suffix:
Gender:F
Credentials:PHD, LPC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 YORKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1107
Mailing Address - Country:US
Mailing Address - Phone:586-770-8167
Mailing Address - Fax:
Practice Address - Street 1:1321 YORKSHIRE RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE PARK
Practice Address - State:MI
Practice Address - Zip Code:48230-1107
Practice Address - Country:US
Practice Address - Phone:586-770-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-10
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009125101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool