Provider Demographics
NPI:1023453040
Name:BROCKSCHMIDT, AMY REBECCA (LLPC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:REBECCA
Last Name:BROCKSCHMIDT
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 1:2305 E PARIS AVE SE
Mailing Address - Street 2:ST. 203
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2426
Mailing Address - Country:US
Mailing Address - Phone:616-929-0226
Mailing Address - Fax:
Practice Address - Street 1:TEN16 RECOVERY NETWORK
Practice Address - Street 2:1302 CHATTERTON ST. 2
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624
Practice Address - Country:US
Practice Address - Phone:989-426-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health