MEDICARE: COREY LAU LMSW

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	2024018596	MO

General Provider Information

NPI Number	:	1528890985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY LAU LMSW

Provider Business Mailing Address
First Line	:	1612 S BIG BEND BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 S BIG BEND BLVD
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2208
Country	:	US
Telephone Number	:	314-529-1391
Fax Number	:

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

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	08/15/2024

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