Healthcare Provider Details

I. General information

NPI: 1861840134
Provider Name (Legal Business Name): AMY RENEE MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 OLIVE ST STE 400
SAINT LOUIS MO
63103-2303
US

IV. Provider business mailing address

2436 WESBAY DR
MARYLAND HEIGHTS MO
63043-4106
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3700
  • Fax:
Mailing address:
  • Phone: 314-223-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018018085
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: