Healthcare Provider Details

I. General information

NPI: 1457374381
Provider Name (Legal Business Name): CAROLYN ANN LAFAVRE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN ANN HOWERTER MS

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BELLEVUE AVE
SAINT LOUIS MO
63117
US

IV. Provider business mailing address

1315 LAVEN DEL LANE
SAINT LOUIS MO
63122
US

V. Phone/Fax

Practice location:
  • Phone: 314-647-3558
  • Fax:
Mailing address:
  • Phone: 314-909-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2005031493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: