Basic Information
| Provider Information | |||||||||
| NPI: | 1225594682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCAULEY | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 BRUTUS CT | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630262112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148520991 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12110 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149898100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2019 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041S0200X | 2011009368 | MO | N | Behavioral Health & Social Service Providers | Social Worker | School | 1041C0700X | 2021044349 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.