Provider Demographics
NPI:1174215693
Name:CARMICHAEL, AMY PEDIGO (PHD, MED, MA, LMFT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:PEDIGO
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:PHD, MED, MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LENOX PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1902
Mailing Address - Country:US
Mailing Address - Phone:415-637-6558
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-3013
Practice Address - Country:US
Practice Address - Phone:314-669-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021013089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist