Provider Demographics
NPI:1295126845
Name:STOCKTON, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:STOCKTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 DEADRA DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4669
Mailing Address - Country:US
Mailing Address - Phone:417-532-7102
Mailing Address - Fax:417-532-6606
Practice Address - Street 1:1216 DEADRA DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4669
Practice Address - Country:US
Practice Address - Phone:417-532-7102
Practice Address - Fax:417-532-6606
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015002497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional