Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | MH19637 | FL |
Y | 101YP2500X | Professional Counselor | 2011041049 | MO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1063531739 |
---|---|
Provider Name | Amber Faithe Lancaster |
First Address | Clinton, MO 64735-8804 |
Second Address | Clinton, MO 64735-8804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 02/09/2021 |