Healthcare Provider Details

I. General information

NPI: 1659595890
Provider Name (Legal Business Name): AMY N BALLHEIMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/25/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE STE 2600
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-1700
  • Fax: 314-286-1777
Mailing address:
  • Phone: 314-286-1700
  • Fax: 314-286-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2011002396
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: