Healthcare Provider Details

I. General information

NPI: 1083170419
Provider Name (Legal Business Name): LILLIAN CARL PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2019
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 W FLORISSANT AVE
FLORISSANT MO
63033-6744
US

IV. Provider business mailing address

118 N 2ND ST
SAINT CHARLES MO
63301-2832
US

V. Phone/Fax

Practice location:
  • Phone: 314-972-8132
  • Fax: 314-830-2565
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-946-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018039740
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: