Individual provider Active NPI

Amy Jane Devore, LPC

  • Professional Counselor
  • Valley Park, MO
National Provider Identifier
1215540844
Registry record updated Aug 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
200603292012 Issued in MO
Practice address
217 Bracadale Ave
Valley Park, MO 63088-1536
Phone
(314) 482-3339
NPI assigned
Aug 24, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 200603292012 MO Primary

Addresses

Primary practice location

217 Bracadale Ave
Valley Park, MO 63088-1536

Mailing address

217 Bracadale Ave
Valley Park, MO 63088-1536
Phone (314) 482-3339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240710002949 MO Practitioner - Mental Health Counselor 5092250431 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
200603292012MOMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Doctor on Demand Professionals P C CurrentSince May 3, 2024 Accepting new patients

Locations

1 California St
Ste 2300
San Francisco, CA 94111
Phone (800) 929-0926

221 Bolivar St
Jefferson Cty, MO 65101
Phone 56129936671572

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598227200000",
    "number": "1215540844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 BRACADALE AVE",
            "city": "VALLEY PARK",
            "state": "MO",
            "postal_code": "630881536",
            "telephone_number": "314-482-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 BRACADALE AVE",
            "city": "VALLEY PARK",
            "state": "MO",
            "postal_code": "630881536",
            "telephone_number": "314-482-3339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVORE",
        "first_name": "AMY",
        "middle_name": "JANE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-08-24",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "200603292012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Park, MO

Sources for this page

Verify at the official NPI Registry.