Provider Demographics
NPI:1598017006
Name:WERTENBERGER, AMY BETH (LLPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:BETH
Last Name:WERTENBERGER
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-9297
Mailing Address - Country:US
Mailing Address - Phone:734-384-3402
Mailing Address - Fax:734-384-3158
Practice Address - Street 1:3250 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-9297
Practice Address - Country:US
Practice Address - Phone:734-384-3402
Practice Address - Fax:734-384-3158
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)