Provider Demographics
NPI:1902680176
Name:FEREDAY, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FEREDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 PRESTON WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-6526
Mailing Address - Country:US
Mailing Address - Phone:314-267-9665
Mailing Address - Fax:
Practice Address - Street 1:2626 PRESTON WOODS TRL
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-6526
Practice Address - Country:US
Practice Address - Phone:314-267-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023015895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional