Provider Demographics
NPI:1831384411
Name:KLEIN, AMY MELISSA (LMSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:MELISSA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WILDERNESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CARP LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49718-9785
Mailing Address - Country:US
Mailing Address - Phone:906-440-1602
Mailing Address - Fax:
Practice Address - Street 1:3434 M 119
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9373
Practice Address - Country:US
Practice Address - Phone:231-348-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical