Provider Demographics
NPI:1225222094
Name:AMY DAVIS LPC, LLC
Entity Type:Organization
Organization Name:AMY DAVIS LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:OLD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-398-9036
Mailing Address - Street 1:8420 DELMAR BLVD
Mailing Address - Street 2:STE. 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2170
Mailing Address - Country:US
Mailing Address - Phone:314-398-9036
Mailing Address - Fax:314-872-8871
Practice Address - Street 1:8420 DELMAR BLVD
Practice Address - Street 2:STE. 300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2170
Practice Address - Country:US
Practice Address - Phone:314-398-9036
Practice Address - Fax:314-872-8871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001009452251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management