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General NPI Number Information
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NPI Number | 1487318689
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Entity Type | Individual
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Provider Name | AMY LOCK LPC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 207 PEACH WAY STE 110
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City | COLUMBIA
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State | MO
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Zip | 65203-4905
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Country | US
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Telephone | 573-777-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 BARRYS BLUFF CT
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City | COLUMBIA
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State | MO
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Zip | 65203-7260
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Country | US
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Telephone | 573-808-1194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2021030533
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License Number State | MO
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