Healthcare Provider Details

I. General information

NPI: 1659043677
Provider Name (Legal Business Name): AMSATT PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 10/03/2021
Certification Date: 10/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 NW EAGLE RIDGE DR
GRAIN VALLEY MO
64029-7248
US

IV. Provider business mailing address

1506 NW EAGLE RIDGE DR
GRAIN VALLEY MO
64029-7248
US

V. Phone/Fax

Practice location:
  • Phone: 913-660-5236
  • Fax:
Mailing address:
  • Phone: 913-660-5236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: AMBRIA MICHELLE WIMSATT
Title or Position: OWNER
Credential:
Phone: 913-660-5236