Healthcare Provider Details

I. General information

NPI: 1265871149
Provider Name (Legal Business Name): ELLEN MICHELLE TOTTEN M.S. LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5639
  • Fax: 847-723-8765
Mailing address:
  • Phone: 314-577-5639
  • Fax: 314-268-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246.000123
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: