Provider Demographics
NPI:1609364595
Name:LILLYWHITE, AMY M (LLBSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:LILLYWHITE
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7760 S M 52
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9265
Mailing Address - Country:US
Mailing Address - Phone:517-285-3626
Mailing Address - Fax:
Practice Address - Street 1:812 E JOLLY RD STE 311
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-6825
Practice Address - Country:US
Practice Address - Phone:517-346-8200
Practice Address - Fax:517-346-8291
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
MI6802090176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No156F00000XEye and Vision Services ProvidersTechnician/Technologist