Basic Information
| Provider Information | |||||||||
| NPI: | 1497126791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECK | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LLPC, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30000 HIVELEY ST | ||||||||
| Address2: | |||||||||
| City: | INKSTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481411089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347283400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4836 WASHTENAW AVE | ||||||||
| Address2: | C7 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481083430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866512971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 6401015157 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.