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General NPI Number Information
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NPI Number | 1659043677
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Entity Type | Organization
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Legal Business Name | AMSATT PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 10/03/2021
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Provider Practice Location Address
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Address Line | 1506 NW EAGLE RIDGE DR
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City | GRAIN VALLEY
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State | MO
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Zip | 64029-7248
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Country | US
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Telephone | 913-660-5236
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 NW EAGLE RIDGE DR
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City | GRAIN VALLEY
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State | MO
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Zip | 64029-7248
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Country | US
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Telephone | 913-660-5236
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMBRIA MICHELLE WIMSATT
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Credential |
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Telephone | 913-660-5236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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