Provider Demographics
NPI:1861944464
Name:PERSCHBACHER, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:PERSCHBACHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 STOCKMAN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4218
Mailing Address - Country:US
Mailing Address - Phone:989-773-3165
Mailing Address - Fax:
Practice Address - Street 1:201 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2527
Practice Address - Country:US
Practice Address - Phone:989-779-8999
Practice Address - Fax:989-779-2219
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-29
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health