Provider Demographics
NPI:1952087652
Name:RICHARD, AMANDA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LYNN
Last Name:RICHARD
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:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MI
Mailing Address - Zip Code:48457-0401
Mailing Address - Country:US
Mailing Address - Phone:810-341-3822
Mailing Address - Fax:
Practice Address - Street 1:3108 VAN VLEET RD
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-8509
Practice Address - Country:US
Practice Address - Phone:810-341-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011136121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical