Provider Demographics
NPI:1275685182
Name:CAMP, AMY LYNN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:CAMP
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4561 S COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-1554
Mailing Address - Country:US
Mailing Address - Phone:314-503-2100
Mailing Address - Fax:314-351-2940
Practice Address - Street 1:4561 S COMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-1554
Practice Address - Country:US
Practice Address - Phone:314-503-2100
Practice Address - Fax:314-351-2940
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002020620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health