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General NPI Number Information
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NPI Number | 1891191276
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE BLOOMFIELD-DEAL M.A., P.L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 851 N KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-2639
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Country | US
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Telephone | 314-965-1801
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Fax | 314-965-1816
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Provider Business Mailing Address
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Address Line | 851 N KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-2639
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Country | US
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Telephone | 314-965-1801
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Fax | 314-965-1816
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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 | 2013042653
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License Number State | MO
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