Provider Demographics
NPI:1215540844
Name:DEVORE, AMY JANE (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:DEVORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BRACADALE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1536
Mailing Address - Country:US
Mailing Address - Phone:314-482-3339
Mailing Address - Fax:
Practice Address - Street 1:217 BRACADALE AVE
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1536
Practice Address - Country:US
Practice Address - Phone:314-482-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200603292012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional