| Doctor Name: | VICKI AMBROSE |
| NPI Number: | 1063889061 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 2009032722 |
| Business Practice Address: | 1776 Crosswinds Dr Wentzville, MO - 633854832 |
| Business Phone Number: | 6363325835 |
| Business Fax Number: | 6363270845 |
| Mailing Address: | 900 E Laharpe St, KIRKSVILLE |
| State: | MO |
| Postal Code: | 635014520 |
| Phone Number: | 6606651962 |
| Fax Number: | 6606653989 |
| NPI Enumeration Date: | 08/25/2015 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 2009032722 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |