Provider Demographics
NPI:1073086955
Name:WIMSATT, AMBRIA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBRIA
Middle Name:MICHELLE
Last Name:WIMSATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S BUSINESS HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1515
Mailing Address - Country:US
Mailing Address - Phone:660-259-2440
Mailing Address - Fax:
Practice Address - Street 1:608 MISSOURI ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:MO
Practice Address - Zip Code:64096-8241
Practice Address - Country:US
Practice Address - Phone:877-344-3572
Practice Address - Fax:866-288-4492
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018025722104100000X
KS055411041C0700X
MO20210057841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker