Provider Demographics
NPI:1548330699
Name:AMBERG, JODY JOANNE FRANCES (LPC NCC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:JOANNE FRANCES
Last Name:AMBERG
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NIEHOFF DR
Mailing Address - Street 2:STE B
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025
Mailing Address - Country:US
Mailing Address - Phone:636-938-9192
Mailing Address - Fax:636-587-9536
Practice Address - Street 1:700 NIEHOFF DR
Practice Address - Street 2:STE B
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025
Practice Address - Country:US
Practice Address - Phone:636-938-9192
Practice Address - Fax:636-587-9536
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
113783OtherBLUE CROSS BLUE SHIELD
282452OtherMHN
336404OtherVALUEOPTIONS
140673OtherCMR
6298062OtherUNITED HEALTH CARE
486600OtherHEALTHLINK NON PAR
213958000OtherMAGELLAN
6298062OtherUNITED HEALTH CARE