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General NPI Number Information
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NPI Number | 1740532050
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Entity Type | Individual
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Provider Name | AMY MARIE FITZWATER PLPC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2012
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Last Update Date | 10/10/2012
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Provider Practice Location Address
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Address Line | 601 W NIFONG BLVD SUITE 1B, BUILDING 1
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City | COLUMBIA
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State | MO
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Zip | 65203-6804
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Country | US
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Telephone | 573-442-9669
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Fax |
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Provider Business Mailing Address
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Address Line | 1838 PINNACLE POINT DR
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City | HOLTS SUMMIT
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State | MO
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Zip | 65043-2065
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Country | US
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Telephone | 573-424-2654
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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 | 2011033841
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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