Provider Demographics
NPI:1952190746
Name:AMY PERRICONE THERAPY LLC
Entity type:Organization
Organization Name:AMY PERRICONE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRICONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:269-998-5035
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MI
Mailing Address - Zip Code:49406-0466
Mailing Address - Country:US
Mailing Address - Phone:269-998-5035
Mailing Address - Fax:
Practice Address - Street 1:720 E 8TH ST STE 3
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3079
Practice Address - Country:US
Practice Address - Phone:269-998-5035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty