Provider Demographics
NPI:1982433173
Name:AMANDA REISTER COUNSELING LLC
Entity type:Organization
Organization Name:AMANDA REISTER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REISTER
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:248-346-6145
Mailing Address - Street 1:2801 MASEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1948
Mailing Address - Country:US
Mailing Address - Phone:248-346-6145
Mailing Address - Fax:
Practice Address - Street 1:2242 S TELEGRAPH RD STE 206
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0218
Practice Address - Country:US
Practice Address - Phone:248-346-6145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)