MEDICARE: JUDY DABLER

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	101YP2500X	Professional Counselor	1999139750	MO

General Provider Information

NPI Number	:	1114323920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY DABLER

Provider Business Mailing Address
First Line	:	11469 OLIVE BLVD # 205
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-7108
Country	:	US
Telephone Number	:	314-477-4521
Fax Number	:

Provider Business Practice Location Address
First Line	:	11780 BORMAN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4135
Country	:	US
Telephone Number	:	314-477-4521
Fax Number	:

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

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	11/06/2014

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Directions to “ JUDY DABLER ” Practice Location

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