Healthcare Provider Details

I. General information

NPI: 1780165183
Provider Name (Legal Business Name): ANCHIN LIAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N GORE AVE
SAINT LOUIS MO
63119-1600
US

IV. Provider business mailing address

2340 S COMPTON AVE
SAINT LOUIS MO
63104-1706
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-2060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018030579
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: