Individual
AMANDA COWART DERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804
(417) 761-5000
(417) 761-5065
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2006025361
MO
Other
Enumeration date
07/09/2018
Last updated
01/15/2019
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