Provider Demographics
NPI:1780462317
Name:RATZ, AMANDA MARET (LPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARET
Last Name:RATZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7436 WISE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1623
Mailing Address - Country:US
Mailing Address - Phone:636-236-7079
Mailing Address - Fax:
Practice Address - Street 1:845 N NEW BALLAS CT STE 310
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7169
Practice Address - Country:US
Practice Address - Phone:314-934-0551
Practice Address - Fax:314-272-3952
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020028365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional