Healthcare Provider Details

I. General information

NPI: 1801211081
Provider Name (Legal Business Name): ELIZABETH MOYER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 RIDGELAWN LN
SAINT PETERS MO
63376-4343
US

IV. Provider business mailing address

1709 RIDGELAWN LN
SAINT PETERS MO
63376-4343
US

V. Phone/Fax

Practice location:
  • Phone: 636-626-8992
  • Fax:
Mailing address:
  • Phone: 636-626-8992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2015016818
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: