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General NPI Number Information
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NPI Number | 1043421480
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Entity Type | Organization
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Legal Business Name | AMELIA DAVENPORT, CONCINNITY GROUP
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 01/04/2009
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Provider Practice Location Address
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Address Line | 1104 SE GRAHAM RIDGE RD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-4101
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Country | US
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Telephone | 816-225-0562
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 SE GRAHAM RIDGE RD
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City | BLUE SPRINGS
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State | MO
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Zip | 64014-4101
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Country | US
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Telephone | 816-225-0562
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMELIA S. DAVENPORT
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Credential | PSY.D.
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Telephone | 816-225-0562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-2004033828
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP-1639
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 2007015259
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License Number State | MO
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