Healthcare Provider Details

I. General information

NPI: 1467515817
Provider Name (Legal Business Name): TERESE W EVANS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 HIGHWAY N
O FALLON MO
63368-7013
US

IV. Provider business mailing address

2440 POCAHONTAS PL
SAINT LOUIS MO
63144-2104
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-7080
  • Fax: 636-561-0463
Mailing address:
  • Phone: 503-679-8819
  • Fax: 636-561-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003023374
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: