Healthcare Provider Details

I. General information

NPI: 1184773285
Provider Name (Legal Business Name): STACEY NENTWIG GREER M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N NEW BALLAS RD SUITE 195
CREVE COEUR MO
63141-6814
US

IV. Provider business mailing address

425 N NEW BALLAS RD SUITE 195
CREVE COEUR MO
63141-6814
US

V. Phone/Fax

Practice location:
  • Phone: 314-999-1566
  • Fax: 314-991-0666
Mailing address:
  • Phone: 314-999-1566
  • Fax: 314-991-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002563
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: