MEDICARE: AMANDA MARET RATZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2020028365	MO

General Provider Information

NPI Number	:	1780462317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARET RATZ LPC

Provider Business Mailing Address
First Line	:	7436 WISE AVE
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1623
Country	:	US
Telephone Number	:	636-236-7079
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 N NEW BALLAS CT STE 310
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7169
Country	:	US
Telephone Number	:	314-934-0551
Fax Number	:	314-272-3952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	09/15/2023

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