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General NPI Number Information
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NPI Number | 1407423684
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Entity Type | Individual
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Provider Name | MARQUISE MIDDLETON LPC
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Gender | Male
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 7520 NATURAL BRIDGE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63121-4903
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Country | US
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Telephone | 314-222-4877
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Fax |
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Provider Business Mailing Address
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Address Line | 3480 SANTIAGO DR
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City | FLORISSANT
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State | MO
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Zip | 63033-2851
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Country | US
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Telephone | 314-410-9596
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2021018624
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License Number State | MO
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