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General NPI Number Information
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NPI Number | 1124493952
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Entity Type | Individual
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Provider Name | LAUREN MICHEL MADDOX
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Gender | Female
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Dates
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Enumeration Date | 12/04/2015
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Last Update Date | 12/04/2015
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Provider Practice Location Address
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Address Line | 4485 WESTMINSTER PL
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1812
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Country | US
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Telephone | 314-956-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 PORTIS AVE APT 1N
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City | SAINT LOUIS
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State | MO
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Zip | 63116-2031
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Country | US
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Telephone | 217-816-2693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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