Amanda Dawn Axelrod, MS, LLMFT

Key facts

NPI

1093548802

Entity type

Individual (NPI type 1)

Primary specialty

Marriage & Family Therapist 106H00000X

License

4151001155 (MI)

Practice address

711 E Grand River Ave Ste a
Brighton, MI 48116-2474

Phone

(936) 446-9476

NPI assigned

Aug 26, 2024

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 26, 2024.

{
    "created_epoch": "1724630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1093548802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27112 GATEWAY DR S APT 106",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483344954",
            "telephone_number": "936-446-9476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 E GRAND RIVER AVE STE A",
            "city": "BRIGHTON",
            "state": "MI",
            "postal_code": "481162474",
            "telephone_number": "936-446-9476"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27112 Gateway Dr S Apt 106",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483344954",
            "country_code": "US",
            "telephone_number": "936-446-9476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AXELROD",
        "first_name": "AMANDA",
        "middle_name": "DAWN",
        "credential": "MS, LLMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-26",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MI",
            "license": "4151001155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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