Provider Demographics
NPI:1316633639
Name:BISHOP, AMANDA RENEE (LLPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:RENEE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10436 FARRAND RD # 10436
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48463-9771
Mailing Address - Country:US
Mailing Address - Phone:989-545-2165
Mailing Address - Fax:
Practice Address - Street 1:5397 MILLINGTON RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MI
Practice Address - Zip Code:48746-8701
Practice Address - Country:US
Practice Address - Phone:989-871-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451014920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional