Healthcare Provider Details

I. General information

NPI: 1255563078
Provider Name (Legal Business Name): AMANDA LIENAU PURNELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

1421 DAUTEL LN
SAINT LOUIS MO
63146-5488
US

V. Phone/Fax

Practice location:
  • Phone: 614-507-7572
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number017993-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: