Individual
AMANDA DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
500 E 19TH ST, MOUNTAIN GROVE, MO 65711-1114
(417) 926-6563
(417) 926-5820
Mailing address
500 E 19TH ST, MOUNTAIN GROVE, MO 65711-1114
(417) 926-6563
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2016016660
MO
1041C0700X
Clinical Social Worker
—
MO
Other
Enumeration date
06/22/2016
Last updated
02/11/2019
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