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NPI Code Detail

MEDICARE: MISS ANITA KAY KUEHLEM-DOROGHAZI LCPC

MEDICARE: MISS ANITA KAY KUEHLEM-DOROGHAZI LCPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor180005653IL
2101YM0800XMental Health Counselor180-005653IL
3101YP2500XProfessional Counselor180005653IL

General Provider Information

NPI Number : 1063566081
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS ANITA KAY KUEHLEM-DOROGHAZI LCPC
Provider Business Mailing Address
First Line : 1539 SURFSIDE DRIVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63138
Country : US
Telephone Number : 618-877-4420
Fax Number : 618-877-9250
Provider Business Practice Location Address
First Line : 2615 EDWARDS ST
Second Line :
City : ALTON
State : IL
Zip : 62002-3915
Country : US
Telephone Number : 618-462-2331
Fax Number : 618-462-2504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 07/16/2012

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