Provider Demographics
NPI:1790433985
Name:CONVERSE, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:CONVERSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 E MOUNT MORRIS ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458-2070
Mailing Address - Country:US
Mailing Address - Phone:810-547-1472
Mailing Address - Fax:
Practice Address - Street 1:731 E MOUNT MORRIS ST STE 6
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458-2070
Practice Address - Country:US
Practice Address - Phone:810-547-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor