Healthcare Provider Details

I. General information

NPI: 1336531631
Provider Name (Legal Business Name): MEGAN ELIZABETH BAX MSW/LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MOEHRLE

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 LADUE RD
SAINT LOUIS MO
63141-8120
US

IV. Provider business mailing address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-4340
  • Fax: 314-842-2552
Mailing address:
  • Phone: 143-716-5003
  • Fax: 314-371-6508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2018036486
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007929A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: