Provider Demographics
NPI:1053541987
Name:PATELLA, AMY C (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:C
Last Name:PATELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 34TH ST
Mailing Address - Street 2:P.O. BOX 2526
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3924
Mailing Address - Country:US
Mailing Address - Phone:417-347-7520
Mailing Address - Fax:417-347-7519
Practice Address - Street 1:2428 E 117TH ST
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1269
Practice Address - Country:US
Practice Address - Phone:612-444-3000
Practice Address - Fax:612-444-9000
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009026801103TC0700X
MNLP6507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical