Provider Demographics
NPI:1790001139
Name:AMARANTH COUNSELING, LLC
Entity type:Organization
Organization Name:AMARANTH COUNSELING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICKA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CALDERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, PSCD
Authorized Official - Phone:636-578-2836
Mailing Address - Street 1:20 PORTWEST CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5985
Mailing Address - Country:US
Mailing Address - Phone:636-578-2836
Mailing Address - Fax:877-433-3107
Practice Address - Street 1:20 PORTWEST CT
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5985
Practice Address - Country:US
Practice Address - Phone:636-578-2836
Practice Address - Fax:877-433-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010010537261Q00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000000631722OtherBCBSIL
IL999018OtherHEALTHLINK