MEDICARE: MS. DEBORAH ANN PRICE 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	02696	MO
2	101YP2500X	Professional Counselor	CS002696	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	213189	OTHER	MO	ANTHEM BLCROSSBL SHIELD

General Provider Information

NPI Number	:	1568668846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH ANN PRICE LPC

Provider Business Mailing Address
First Line	:	4144 LINDELL BOULEVARD
Second Line	:	SUITE 134
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108
Country	:	US
Telephone Number	:	314-440-2029
Fax Number	:	314-645-3981

Provider Business Practice Location Address
First Line	:	4144 LINDELL BLVD
Second Line	:	SUITE 402
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2927
Country	:	US
Telephone Number	:	314-780-3854
Fax Number	:	314-645-3981

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	05/26/2021

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