Provider Demographics
NPI:1649042748
Name:BOYLE, AMANDA (MA LLC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MA LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4317
Mailing Address - Country:US
Mailing Address - Phone:989-954-4673
Mailing Address - Fax:
Practice Address - Street 1:1001 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-4317
Practice Address - Country:US
Practice Address - Phone:989-954-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool