Provider Demographics
NPI:1912517632
Name:WILLARD, AMY CHRISTEEN (PLPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTEEN
Last Name:WILLARD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTEEN
Other - Last Name:BABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 RALEIGH HILL CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-7284
Mailing Address - Country:US
Mailing Address - Phone:636-352-7695
Mailing Address - Fax:
Practice Address - Street 1:332 STABLE LN
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-5447
Practice Address - Country:US
Practice Address - Phone:636-332-4949
Practice Address - Fax:636-332-4941
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018045624101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health