Amanda Larson, M.A., MLP

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

6301015820 Issued in MI

Practice address

1514 Wealthy St SE Ste 256
Grand Rapids, MI 49506-2755

Phone

(616) 780-1284

Fax

(616) 427-1624

NPI assigned

Mar 13, 2014

Last updated

Dec 28, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amanda Willis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Larson DBT Counseling Services PLLC

  • Counseling Psychologist
  • Caledonia, MI
  • NPI 1043775729
  NPD Authorized official
• Meredith Psychological and Testing Services, LLC

  • Clinical Psychologist
  • Kalamazoo, MI
  • NPI 1558735266
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672185600000",
    "number": "1609292713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 WEALTHY ST SE STE 256",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062755",
            "telephone_number": "616-780-1284",
            "fax_number": "616-427-1624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 WEALTHY ST SE STE 256",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062755",
            "telephone_number": "616-780-1284",
            "fax_number": "616-427-1624"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1009 44th St SW",
            "address_2": "103",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "49509",
            "country_code": "US",
            "telephone_number": "616-734-6900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "AMANDA",
        "credential": "M.A., MLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-13",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "MI",
            "license": "6301015820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "WILLIS",
            "credential": "MA., LLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Steven David Larowe, PH.D.
• Carlee Larsen
• Dergaso Larsen
• Kathryn Mae Larsen
• Micah Larsen, MD
• Bryonna Larson
• Catheryn Ann Larson, FNP
• Elaine P Larson, OT CHT
• Eric Lee Larson, MD
• Halie Larson

• Counseling Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Counseling Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.