Healthcare Provider Details

I. General information

NPI: 1245839190
Provider Name (Legal Business Name): CARMEN V IHRIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HILLTOP VILLAGE CENTER DR
EUREKA MO
63025-3922
US

IV. Provider business mailing address

97 HILLTOP VILLAGE CENTER DR
EUREKA MO
63025-3922
US

V. Phone/Fax

Practice location:
  • Phone: 314-374-1620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2005029337
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: