Provider Demographics
NPI:1932641560
Name:CLEMENTS, AMANDA (LLPC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CLEMENTS
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 1:2404 S STEPHAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-9414
Mailing Address - Country:US
Mailing Address - Phone:219-405-0006
Mailing Address - Fax:
Practice Address - Street 1:2404 S STEPHAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-9414
Practice Address - Country:US
Practice Address - Phone:219-405-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451018871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health