MEDICARE: MISS AMBER BRIANA JONES PSYD

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	103TC0700X	Clinical Psychologist	2006036650	MO

General Provider Information

NPI Number	:	1962560086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMBER BRIANA JONES PSYD

Provider Business Mailing Address
First Line	:	3394 MCKELVEY RD
Second Line	:	STE. 116
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2531
Country	:	US
Telephone Number	:	314-209-0900
Fax Number	:	314-209-0912

Provider Business Practice Location Address
First Line	:	3394 MCKELVEY RD
Second Line	:	STE. 116
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2531
Country	:	US
Telephone Number	:	314-209-0900
Fax Number	:	314-209-0912

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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