Healthcare Provider Details

I. General information

NPI: 1134974355
Provider Name (Legal Business Name): AMITY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 N CHERRY ST
GLADSTONE MO
64118-2644
US

IV. Provider business mailing address

7101 N CHERRY ST
GLADSTONE MO
64118-2644
US

V. Phone/Fax

Practice location:
  • Phone: 816-400-8739
  • Fax:
Mailing address:
  • Phone: 816-400-8739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA LEMON
Title or Position: PRESIDENT, CO-FOUNDER, CO-CEO, CXO
Credential:
Phone: 816-400-8739