Provider Demographics
NPI:1639384803
Name:JAMES, AMY M (PLPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:JAMES
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-0365
Mailing Address - Country:US
Mailing Address - Phone:636-937-7727
Mailing Address - Fax:636-931-7553
Practice Address - Street 1:660 N CREEK DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2632
Practice Address - Country:US
Practice Address - Phone:636-937-7727
Practice Address - Fax:636-931-7553
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006038348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006038348OtherPROVISIONAL LICENSE