MEDICARE: MRS. JERRI ANN VERITY M.ED., LPC, NCC

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	174400000X	Specialist	2002032137	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	175969	OTHER	MO	BCBS ID

General Provider Information

NPI Number	:	1710029426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JERRI ANN VERITY M.ED., LPC, NCC

Provider Business Mailing Address
First Line	:	2649 CAMINO DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-3812
Country	:	US
Telephone Number	:	314-544-8189
Fax Number	:	314-544-8189

Provider Business Practice Location Address
First Line	:	4177 CRESCENT DR
Second Line	:	SUITE D
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1071
Country	:	US
Telephone Number	:	314-680-8190
Fax Number	:	314-544-8189

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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