MEDICARE: MRS. ELIZABETH KAY RANHEIM 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	2020021140	MO

General Provider Information

NPI Number	:	1740021450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH KAY RANHEIM LPC

Provider Business Mailing Address
First Line	:	1000 EXECUTIVE PARKWAY DR STE 106
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6369
Country	:	US
Telephone Number	:	314-469-5522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 EXECUTIVE PARKWAY DR
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6325
Country	:	US
Telephone Number	:	314-469-5522
Fax Number	:

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

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	06/05/2024

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