Healthcare Provider Details

I. General information

NPI: 1619059151
Provider Name (Legal Business Name): REBECCA CORINNE TURAY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAKE SAINT LOUIS BLVD STE 204
LAKE ST LOUIS MO
63367-1340
US

IV. Provider business mailing address

1811 HEATHER GLEN CT
LAKE ST LOUIS MO
63367-4245
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-5673
  • Fax: 636-639-6755
Mailing address:
  • Phone: 636-332-4487
  • Fax: 636-639-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW004640
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: