Healthcare Provider Details

I. General information

NPI: 1851663439
Provider Name (Legal Business Name): TRICIA LEA GEBHARD-LOVELL P-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 OLIVE ST STE 500
SAINT LOUIS MO
63103-2377
US

IV. Provider business mailing address

1430 OLIVE, SUITE 500
ST. LOUIS MO
63103-2377
US

V. Phone/Fax

Practice location:
  • Phone: 314-206-3700
  • Fax:
Mailing address:
  • Phone: 314-206-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2009029481
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: