Healthcare Provider Details

I. General information

NPI: 1346329836
Provider Name (Legal Business Name): BETH ANN MILLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

IV. Provider business mailing address

431 S HARRISON AVE
KIRKWOOD MO
63122-5803
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-9350
  • Fax: 314-533-6047
Mailing address:
  • Phone: 314-821-3322
  • Fax: 314-821-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2003016380
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: