Provider Demographics
NPI:1306071634
Name:EMBURY, AMY KAY (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KAY
Last Name:EMBURY
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9673 CANDYTUFT LANE
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053
Mailing Address - Country:US
Mailing Address - Phone:269-665-6572
Mailing Address - Fax:
Practice Address - Street 1:9673 CANDYTUFT
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-7724
Practice Address - Country:US
Practice Address - Phone:269-665-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010648103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling