=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548330699
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODY JOANNE FRANCES AMBERG LPC NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 05/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 NIEHOFF DR STE B
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-938-9192
-----------------------------------------------------
Fax | 636-587-9536
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 NIEHOFF DR STE B
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-938-9192
-----------------------------------------------------
Fax | 636-587-9536
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | CS002441
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------