Provider Demographics
NPI:1043421480
Name:AMELIA DAVENPORT, CONCINNITY GROUP
Entity Type:Organization
Organization Name:AMELIA DAVENPORT, CONCINNITY GROUP
Other - Org Name:CLINICAL ASSOCIATES, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:816-225-0562
Mailing Address - Street 1:1104 SE GRAHAM RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-4101
Mailing Address - Country:US
Mailing Address - Phone:816-225-0562
Mailing Address - Fax:
Practice Address - Street 1:1104 SE GRAHAM RIDGE RD
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-4101
Practice Address - Country:US
Practice Address - Phone:816-225-0562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLPC-2004033828101YM0800X
KSLP-1639103T00000X
MO2007015259103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty