Healthcare Provider Details

I. General information

NPI: 1164067195
Provider Name (Legal Business Name): LISA ANN ADAMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6708
US

IV. Provider business mailing address

213 VICTORY LN
SAINT CHARLES MO
63303-8432
US

V. Phone/Fax

Practice location:
  • Phone: 314-610-8707
  • Fax:
Mailing address:
  • Phone: 314-610-8707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2011035730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: