MEDICARE: STEVEN MAX AWTREY 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	2001011550	MO

General Provider Information

NPI Number	:	1356513824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MAX AWTREY LPC

Provider Business Mailing Address
First Line	:	18 N IOLA DR
Second Line	:
City	:	WEBSTER GROVES
State	:	MO
Zip	:	63119-2226
Country	:	US
Telephone Number	:	314-968-2216
Fax Number	:	314-968-2335

Provider Business Practice Location Address
First Line	:	7955 BIG BEND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-2703
Country	:	US
Telephone Number	:	314-968-2216
Fax Number	:	314-968-2335

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

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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