MEDICARE: LISA ELAINE WHITE LPC

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1225378490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ELAINE WHITE LPC

Provider Business Mailing Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7839
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 S LINDBERGH BLVD
Second Line	:	SUITE 201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-7839
Country	:	US
Telephone Number	:	314-221-8206
Fax Number	:

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

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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