Provider Demographics
NPI:1043973282
Name:WILLIAMSON, AMY LAUREN (MA)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LAUREN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-1836
Mailing Address - Country:US
Mailing Address - Phone:573-275-9059
Mailing Address - Fax:
Practice Address - Street 1:810 E JACKSON BLVD STE B1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2400
Practice Address - Country:US
Practice Address - Phone:573-213-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021040845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health