Healthcare Provider Details

I. General information

NPI: 1326200494
Provider Name (Legal Business Name): ANNALISE MILLET MSW,LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 DELMAR BLVD SUITE 300
SAINT LOUIS MO
63124-2170
US

IV. Provider business mailing address

2510 SOUTH BRENTWOOD AVE SUITE 204 SUITE 300
SAINT LOUIS MO
63144-2326
US

V. Phone/Fax

Practice location:
  • Phone: 314-516-6798
  • Fax:
Mailing address:
  • Phone: 314-516-6798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: