Healthcare Provider Details

I. General information

NPI: 1073998613
Provider Name (Legal Business Name): LIFE WITHOUT ANXIETY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COACHMAN LN
VILLA RIDGE MO
63089-1901
US

IV. Provider business mailing address

111 PROSPECT AVE SUITE 203A
KIRKWOOD MO
63122-6052
US

V. Phone/Fax

Practice location:
  • Phone: 314-467-0540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELISABETH BRAWLEY
Title or Position: ANXIETY SPECIALIST
Credential: MA, PLPC
Phone: 314-467-0540