Healthcare Provider Details

I. General information

NPI: 1649940404
Provider Name (Legal Business Name): EILEEN M VOLLMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2021
Last Update Date: 09/14/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 MACKLIND AVE
SAINT LOUIS MO
63110-1440
US

IV. Provider business mailing address

PO BOX 9662
ASHEVILLE NC
28815-0662
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-0200
  • Fax: 636-532-9951
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018045629
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: