Healthcare Provider Details

I. General information

NPI: 1881060333
Provider Name (Legal Business Name): AMY GLENN BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY GLENN

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CEDAR HILL EST
CEDAR HILL MO
63016-2224
US

IV. Provider business mailing address

27 CEDAR HILL EST
CEDAR HILL MO
63016-2224
US

V. Phone/Fax

Practice location:
  • Phone: 636-575-7673
  • Fax:
Mailing address:
  • Phone: 636-575-7673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2023029159
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF70048388
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: