Provider Demographics
NPI:1639102189
Name:RATHUR, AMENA (LLMSW)
Entity Type:Individual
Prefix:
First Name:AMENA
Middle Name:
Last Name:RATHUR
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 15 MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4853
Mailing Address - Country:US
Mailing Address - Phone:586-264-3692
Mailing Address - Fax:586-939-5953
Practice Address - Street 1:2122 15 MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4853
Practice Address - Country:US
Practice Address - Phone:586-264-3692
Practice Address - Fax:586-939-5953
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802083176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI897096OtherBCBS PIN