Provider Demographics
NPI:1568594083
Name:SIDERS, AMELIA BETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:BETH
Last Name:SIDERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 WATER WATCH LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-1620
Mailing Address - Country:US
Mailing Address - Phone:231-392-5562
Mailing Address - Fax:
Practice Address - Street 1:537 S GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3484
Practice Address - Country:US
Practice Address - Phone:231-946-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012929103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist