MEDICARE: DR. MARIANELA DORNHECKER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	37639	TX

General Provider Information

NPI Number	:	1063972081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIANELA DORNHECKER PHD

Provider Business Mailing Address
First Line	:	PO BOX 63174
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63163-3174
Country	:	US
Telephone Number	:	314-669-4706
Fax Number	:

Provider Business Practice Location Address
First Line	:	3832 MCDONALD AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-4717
Country	:	US
Telephone Number	:	314-669-4706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	10/18/2020

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