Healthcare Provider Details

I. General information

NPI: 1902680176
Provider Name (Legal Business Name): AMY FEREDAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 PRESTON WOODS TRL
LAKE SAINT LOUIS MO
63367-6526
US

IV. Provider business mailing address

2626 PRESTON WOODS TRL
LAKE SAINT LOUIS MO
63367-6526
US

V. Phone/Fax

Practice location:
  • Phone: 314-267-9665
  • Fax:
Mailing address:
  • Phone: 314-267-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2023015895
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: