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General NPI Number Information
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NPI Number | 1407365216
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Entity Type | Organization
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Legal Business Name | AMB CONSULTING COUNSELING AND WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1515 N WARSON RD STE 121
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1108
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Country | US
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Telephone | 314-764-5172
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Fax | 314-953-7397
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Provider Business Mailing Address
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Address Line | 1515 N WARSON RD STE 121
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City | SAINT LOUIS
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State | MO
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Zip | 63132-1108
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Country | US
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Telephone | 314-764-5172
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Fax | 314-953-7397
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | MS. ANGELA M BRYANT
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Credential | LCSW
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Telephone | 314-764-5172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 2010039058
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License Number State | MO
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