Provider Demographics
NPI:1295563534
Name:TRUDELL, AMBER LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:TRUDELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12772 STATE ROAD TT
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4345
Mailing Address - Country:US
Mailing Address - Phone:636-232-6145
Mailing Address - Fax:
Practice Address - Street 1:508 N TRUMAN BLVD STE J
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1344
Practice Address - Country:US
Practice Address - Phone:636-232-8328
Practice Address - Fax:888-388-2749
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT092076003104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker