| Amplified Life | |
|
7791 Byron Center Ave Sw Byron Center MI 49315-8412 | |
| (616) 724-6943 | |
| (616) 499-2077 |
| Full Name | Amplified Life |
|---|---|
| Speciality | Counselor |
| Location | 7791 Byron Center Ave Sw, Byron Center, Michigan |
| Authorized Official Name and Position | Lyle Labardee (PRESIDENT) |
| Authorized Official Contact | 6167246943 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amplified Life 7791 Byron Center Ave Sw Byron Center MI 49315-8412 Ph: (616) 724-6943 | Amplified Life 7791 Byron Center Ave Sw Byron Center MI 49315-8412 Ph: (616) 724-6943 |
| NPI Number | 1558713388 |
|---|---|
| Provider Enumeration Date | 07/05/2016 |
| Last Update Date | 09/22/2020 |
| Certification Date | 09/22/2020 |
| Medicare PECOS PAC ID | 7214350271 |
|---|---|
| Medicare Enrollment ID | O20200709000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558713388 | NPI | - | NPPES |
| 1043537574 | Other | MI | GENERAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 6401003943 (Michigan) | Primary |
| 225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
| Provider Name | Hollie Andrews |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497949135 PECOS PAC ID: 5193867836 Enrollment ID: I20100119000632 |
| Provider Name | Leah A Lord |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053635607 PECOS PAC ID: 1557681913 Enrollment ID: I20150526002312 |
| Provider Name | Sabreen Rae Polavin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073904579 PECOS PAC ID: 2062772387 Enrollment ID: I20180207000435 |
| Provider Name | Emily Behm Jankowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023474988 PECOS PAC ID: 3375805666 Enrollment ID: I20180327000165 |
| Provider Name | Katie Jo Reichard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780067546 PECOS PAC ID: 2365866738 Enrollment ID: I20200717001047 |
| Provider Name | Cathlene J Young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508338864 PECOS PAC ID: 4587074349 Enrollment ID: I20201105001699 |
| Provider Name | Amy Beth Harbison |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376128546 PECOS PAC ID: 9638560519 Enrollment ID: I20220104000836 |
| Provider Name | Ruth Gray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346665098 PECOS PAC ID: 1557731122 Enrollment ID: I20221227000131 |
| Provider Name | Dawn Rodgers-de Fouw |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609599380 PECOS PAC ID: 3375993702 Enrollment ID: I20231228000676 |
| Provider Name | Michael John Wiersma |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265920342 PECOS PAC ID: 4880037415 Enrollment ID: I20240209003043 |
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