Healthcare Provider Details

I. General information

NPI: 1336260314
Provider Name (Legal Business Name): LISA MARIE SCHUITO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 FAIRGROUNDS RD STE 128
SAINT CHARLES MO
63301-2469
US

IV. Provider business mailing address

315 N WILSON HEIGHTS RD
COLLINSVILLE IL
62234-5546
US

V. Phone/Fax

Practice location:
  • Phone: 314-707-4364
  • Fax:
Mailing address:
  • Phone: 314-707-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2001029771
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: