Provider Demographics
NPI:1780471433
Name:MCGLOTHEN, AMY (SWT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MCGLOTHEN
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 E JOLLY RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-6825
Mailing Address - Country:US
Mailing Address - Phone:517-237-7162
Mailing Address - Fax:
Practice Address - Street 1:5913 EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-5341
Practice Address - Country:US
Practice Address - Phone:517-237-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803089031106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician