Provider Demographics
NPI:1164781639
Name:VINSON, AMY B (PLPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:B
Last Name:VINSON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 BUMBLE BEE LANE
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-8640
Mailing Address - Country:US
Mailing Address - Phone:573-513-5193
Mailing Address - Fax:573-701-0330
Practice Address - Street 1:118 WEST PINE PLAZA
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1403
Practice Address - Country:US
Practice Address - Phone:573-513-5193
Practice Address - Fax:573-701-0330
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011009755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health