Healthcare Provider Details

I. General information

NPI: 1881310084
Provider Name (Legal Business Name): EMILIE J PATERSON MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 5TH ST STE 201
SAINT CHARLES MO
63301-1808
US

IV. Provider business mailing address

362 SCARSDALE CIR
LAKE OZARK MO
65049-5403
US

V. Phone/Fax

Practice location:
  • Phone: 636-277-9890
  • Fax:
Mailing address:
  • Phone: 205-531-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021039444
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: