Healthcare Provider Details

I. General information

NPI: 1831019629
Provider Name (Legal Business Name): NATANIA LIPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14377 WOODLAKE DR STE 315
TOWN AND COUNTRY MO
63017-5735
US

IV. Provider business mailing address

18 S KINGSHIGHWAY BLVD APT 1M
SAINT LOUIS MO
63108-1387
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-0941
  • Fax:
Mailing address:
  • Phone: 502-291-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2025043330
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: