MEDICARE: MARQUISE MIDDLETON 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	101YP2500X	Professional Counselor	2021018624	MO

General Provider Information

NPI Number	:	1407423684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUISE MIDDLETON LPC

Provider Business Mailing Address
First Line	:	3480 SANTIAGO DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63033-2851
Country	:	US
Telephone Number	:	314-410-9596
Fax Number	:

Provider Business Practice Location Address
First Line	:	7520 NATURAL BRIDGE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4903
Country	:	US
Telephone Number	:	314-222-4877
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	10/27/2025

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Directions to “ MARQUISE MIDDLETON LPC” Practice Location

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