| Amanda L Woollard Ma Lpc, Llc | |
|
4121 Union Rd Ste 225 Saint Louis MO 63129-1093 | |
| (314) 730-6787 | |
| (314) 730-6585 |
| Full Name | Amanda L Woollard Ma Lpc, Llc |
|---|---|
| Speciality | Counselor |
| Location | 4121 Union Rd Ste 225, Saint Louis, Missouri |
| Authorized Official Name and Position | Amanda L Woollard (OWNER) |
| Authorized Official Contact | 6186048326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda L Woollard Ma Lpc, Llc 8539 Talma Ct Affton MO 63123-3633 Ph: (618) 604-8326 | Amanda L Woollard Ma Lpc, Llc 4121 Union Rd Ste 225 Saint Louis MO 63129-1093 Ph: (314) 730-6787 |
| NPI Number | 1831873504 |
|---|---|
| Provider Enumeration Date | 06/13/2023 |
| Last Update Date | 06/13/2023 |
| Certification Date | 06/13/2023 |
| Medicare PECOS PAC ID | 5890131437 |
|---|---|
| Medicare Enrollment ID | O20240306001452 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831873504 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Amanda L Woollard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972888584 PECOS PAC ID: 8628415866 Enrollment ID: I20240325000278 |
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