MEDICARE: JEANINE MARIE VALLEROY PH.D.; LCSW

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
1	101YM0800X	Mental Health Counselor	002610	MO

General Provider Information

NPI Number	:	1568429850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANINE MARIE VALLEROY PH.D.; LCSW

Provider Business Mailing Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7802
Country	:	US
Telephone Number	:	314-894-2900
Fax Number	:	314-894-2942

Provider Business Practice Location Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7802
Country	:	US
Telephone Number	:	314-894-2900
Fax Number	:	314-894-2942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/09/2007

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