Provider Demographics
NPI:1346927308
Name:AMY J. STARK, LLC
Entity Type:Organization
Organization Name:AMY J. STARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/MANAGER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-971-5272
Mailing Address - Street 1:729 CHIPPENDALE CT
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5705
Mailing Address - Country:US
Mailing Address - Phone:314-971-5272
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD STE 370
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3025
Practice Address - Country:US
Practice Address - Phone:314-971-5272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty