Amanda Renee Southern, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801094249 Issued in MI

Practice address

275 S State Rd
Otisville, MI 48463-8436

Phone

(810) 922-7700

NPI assigned

Mar 7, 2013

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

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tranquil Life Counseling LLCGroup PAC ID 7618355256, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Tranquil Life Counseling LLC

  • Mental Health Counselor
  • Otisville, MI
  • NPI 1851958151
  Medicare reassignment Care Compare group NPD Authorized official
• Training & Treatment Innovations Inc

  • Community/Behavioral Health Agency
  • Oxford, MI
  • NPI 1609857978
  Medicare reassignment NPD
• Training and Treatment Innovations Inc

  • Public Health or Welfare Agency
  • Sterling Heights, MI
  • NPI 1295084721
  NPD

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

{
    "created_epoch": "1362614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652745600000",
    "number": "1982945549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 S STATE RD",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "484638436",
            "telephone_number": "810-922-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 S STATE RD",
            "city": "OTISVILLE",
            "state": "MI",
            "postal_code": "484638436",
            "telephone_number": "810-922-7700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "929 Stevens St",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485021620",
            "country_code": "US",
            "telephone_number": "810-232-6081",
            "fax_number": "810-232-6510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHERN",
        "first_name": "AMANDA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-07",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801094249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tijo Thomas Manthuruthil, PHARMD
• Mohamed Ally Health Plaza PLLC
• William E Norton II, D.D.S.
• Otisville Pharmacy LLC
• Rite Aid of Michigan Inc
• Kasey Marie Stark, DDS
• Kathy Taliaferro
• Tranquil Life Counseling LLC
• William Wise

• Clinical Social Worker in Otisville, MI
• Providers in Otisville, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.