Healthcare Provider Details

I. General information

NPI: 1326983172
Provider Name (Legal Business Name): LEJLA OMEROVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK AVE FL 2
SAINT LOUIS MO
63110-2514
US

IV. Provider business mailing address

4329 HAWKINS RIDGE DR
SAINT LOUIS MO
63129-2104
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025001457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: