Active NPI
Amanda Michelle Waidelich, LPC
- Professional Counselor
- Grand Rapids, MI
National Provider Identifier
1700375615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401012853
- Practice address
- 3333 36TH St SE
Grand Rapids, MI 49512-2809 - Phone
- (616) 726-1958
- NPI assigned
- May 7, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Counselor | 101Y00000X | |||
| Professional Counselor | 101YP2500X | 6401012853 | MI | Primary |
Addresses
Primary practice location
3333 36TH St SE
Grand Rapids, MI 49512-2809
Mailing address
3333 36TH St SE
Grand Rapids, MI 49512-2809
Phone (616) 726-1958
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401012853 | MI | MD | Professional Counselor |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Illness Community Based Residential Treatment Facility
- Nunica, MI
- NPI 1043295934
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Sparta, MI
- NPI 1679558670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759276800000",
"number": "1700375615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122809",
"telephone_number": "616-726-1958"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122809",
"telephone_number": "616-726-1958"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAIDELICH",
"first_name": "AMANDA",
"middle_name": "MICHELLE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-07",
"last_updated": "2025-10-01",
"certification_date": "2025-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401012853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.