MEDICARE: MS. CHRISTINE BALLIETT MCEVOY M.A., L.P.C.

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	002641	MO

General Provider Information

NPI Number	:	1821204470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE BALLIETT MCEVOY M.A., L.P.C.

Provider Business Mailing Address
First Line	:	2415 MENARD ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-4329
Country	:	US
Telephone Number	:	314-762-9574
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 S BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:	314-709-5393
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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