Provider Demographics
NPI:1275167264
Name:CARR, AMANDA LEA (MED, NCC, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEA
Last Name:CARR
Suffix:
Gender:F
Credentials:MED, NCC, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 VANCE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1575
Mailing Address - Country:US
Mailing Address - Phone:314-805-4794
Mailing Address - Fax:
Practice Address - Street 1:232 VANCE RD STE 205
Practice Address - Street 2:
Practice Address - City:VALLEY PARK
Practice Address - State:MO
Practice Address - Zip Code:63088-1575
Practice Address - Country:US
Practice Address - Phone:314-805-4794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027175101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty