Individual
AMYLYNN THEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, CAADC
Contact information
Practice address
1205 S MISSION ST, STE 27, MOUNT PLEASANT, MI 48858-3939
(989) 944-2950
(989) 317-3638
Mailing address
121 N LANSING ST, MOUNT PLEASANT, MI 48858-1631
(989) 944-2950
(989) 317-3638
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C-01471
MI
101YP2500X
Professional Counselor
Primary
6401006678
MI
Other
Enumeration date
04/01/2008
Last updated
01/09/2017
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