Provider Demographics
NPI:1497126791
Name:BECK, AMANDA ANN (LLPC, MA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ANN
Last Name:BECK
Suffix:
Gender:F
Credentials:LLPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30000 HIVELEY ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1089
Mailing Address - Country:US
Mailing Address - Phone:734-728-3400
Mailing Address - Fax:
Practice Address - Street 1:4836 WASHTENAW AVE
Practice Address - Street 2:C7
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3430
Practice Address - Country:US
Practice Address - Phone:586-651-2971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015157101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health