Healthcare Provider Details

I. General information

NPI: 1518877042
Provider Name (Legal Business Name): CARRISS DEWITT MA, PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6055 MEXICO RD
SAINT PETERS MO
63376-1632
US

IV. Provider business mailing address

30 N HARRIS DR
SAINT PETERS MO
63376-3523
US

V. Phone/Fax

Practice location:
  • Phone: 636-294-2694
  • Fax: 636-222-9277
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2026041948
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: