Provider Demographics
NPI:1437580537
Name:AMROD, J V (PHD)
Entity Type:Individual
Prefix:MR
First Name:J
Middle Name:V
Last Name:AMROD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JAI
Other - Middle Name:
Other - Last Name:AMROD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:513 OLD 63 N APT 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6371
Mailing Address - Country:US
Mailing Address - Phone:573-443-4761
Mailing Address - Fax:
Practice Address - Street 1:513 OLD 63 N APT 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6371
Practice Address - Country:US
Practice Address - Phone:573-443-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-28
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013761103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist