Healthcare Provider Details

I. General information

NPI: 1811536436
Provider Name (Legal Business Name): THIS WOMAN'S WORK STL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 N MERAMEC AVE STE 304
CLAYTON MO
63105-3750
US

IV. Provider business mailing address

3645 FLAD AVE
SAINT LOUIS MO
63110-4021
US

V. Phone/Fax

Practice location:
  • Phone: 314-435-6393
  • Fax:
Mailing address:
  • Phone: 314-577-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NATALIE MARIE LANNING
Title or Position: MENTAL HEALTH THERAPIST
Credential: MSW, LCSW
Phone: 314-435-6393