Provider Demographics
NPI:1821628686
Name:DAGENAIS, AMY KATHERINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHERINE
Last Name:DAGENAIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 BADGER STREET
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2303
Mailing Address - Country:US
Mailing Address - Phone:906-273-1121
Mailing Address - Fax:906-225-6706
Practice Address - Street 1:2353 BADGER STREET
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2303
Practice Address - Country:US
Practice Address - Phone:906-273-1121
Practice Address - Fax:906-225-6706
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVS0137654Medicaid