Provider Demographics
NPI:1578803367
Name:BANKERT, AMANDA ILENE (LLPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ILENE
Last Name:BANKERT
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ILENE
Other - Last Name:GINTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2218
Mailing Address - Country:US
Mailing Address - Phone:989-390-5391
Mailing Address - Fax:
Practice Address - Street 1:1000 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3445
Practice Address - Country:US
Practice Address - Phone:231-947-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional