Basic Information
| Provider Information | |||||||||
| NPI: | 1871125963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STANEK | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | EVELYN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 655 | ||||||||
| Address2: | |||||||||
| City: | ALPENA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497070655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897369815 | ||||||||
| FaxNumber: | 9893583734 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 STATE ST | ||||||||
| Address2: | |||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2313482110 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2020 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401018141 | MI | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | 6401018141 | MI | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YS0200X | IF0000000335410 | MI | N | Behavioral Health & Social Service Providers | Counselor | School | 101YP2500X | 6401018141 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.