Healthcare Provider Details

I. General information

NPI: 1477876944
Provider Name (Legal Business Name): REBECCA ANNE LAZALIER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS REBECCA ANNE MILLER

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WOODLAWN AVE STE 33
O FALLON MO
63366-7829
US

IV. Provider business mailing address

206 SUTTERS MILL RD
SAINT PETERS MO
63376-2564
US

V. Phone/Fax

Practice location:
  • Phone: 314-640-2256
  • Fax: 636-206-2844
Mailing address:
  • Phone: 314-640-2256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010007551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: