Provider Demographics
NPI:1629568787
Name:RICE, AMANDA NELSON (LLPC, CFTP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:NELSON
Last Name:RICE
Suffix:
Gender:F
Credentials:LLPC, CFTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3364
Mailing Address - Country:US
Mailing Address - Phone:517-712-8495
Mailing Address - Fax:
Practice Address - Street 1:1712 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2825
Practice Address - Country:US
Practice Address - Phone:517-372-9163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015841101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor