MEDICARE: LUTHERAN FAMILY AND CHILDREN'S SERVICES OF MISSOURI

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	101Y00000X	Counselor

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	990001149	OTHER	MO	MEDICARE PTAN

General Provider Information

NPI Number	:	1427082395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUTHERAN FAMILY AND CHILDREN'S SERVICES OF MISSOURI

Provider Business Mailing Address
First Line	:	9666 OLIVE BLVD
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63132-3013
Country	:	US
Telephone Number	:	314-787-5100
Fax Number	:	314-754-2800

Provider Business Practice Location Address
First Line	:	9666 OLIVE BLVD
Second Line	:
City	:	ST. LOUIS
State	:	MO
Zip	:	63132
Country	:	US
Telephone Number	:	314-787-5100
Fax Number	:	314-754-2800

Authorized Official
Title or Position	:	VICE PRESIDENT OF PROGRAMS
Name	:	MS. PAULETTE M FOERSTER
Credential	:	ACSW, LCSW
Telephone Number	:	314-754-2776

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	03/23/2016

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Directions to “LUTHERAN FAMILY AND CHILDREN'S SERVICES OF MISSOURI ” Practice Location

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