Healthcare Provider Details

I. General information

NPI: 1275477598
Provider Name (Legal Business Name): MICHAEL LIPPS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S SAINT PETERS PKWY STE 106
SAINT PETERS MO
63303-5677
US

IV. Provider business mailing address

2730 S SAINT PETERS PKWY STE 106
SAINT PETERS MO
63303-5677
US

V. Phone/Fax

Practice location:
  • Phone: 314-780-9360
  • Fax:
Mailing address:
  • Phone: 314-780-9360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019035932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: