Active NPI
Amy Renee Wilson, PSY.D.
- Clinical Psychologist
- Saint Louis, MO
National Provider Identifier
1972812840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 13829
- Practice address
- 1167 Corporate Lake Dr
Saint Louis, MO 63132-1716 - Phone
- (314) 968-2350
- NPI assigned
- Sep 27, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 13829 | CO | Primary |
| Professional Counselor | 101YP2500X | |||
| Psychologist | 103T00000X | MO |
Addresses
Primary practice location
1167 Corporate Lake Dr
Saint Louis, MO 63132-1716
Mailing address
1167 Corporate Lake Dr
Saint Louis, MO 63132-1716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13829 | CO | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625097600000",
"number": "1972812840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1167 CORPORATE LAKE DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631321716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1167 CORPORATE LAKE DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631321716",
"telephone_number": "314-968-2350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "AMY",
"middle_name": "RENEE",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-27",
"last_updated": "2021-07-01",
"certification_date": "2021-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "13829",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.