MEDICARE: MRS. EMMA LEE VAN DILLEN M.ED, 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	2024046605	MO

General Provider Information

NPI Number	:	1811241441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMMA LEE VAN DILLEN M.ED, LPC

Provider Business Mailing Address
First Line	:	8651 HWY N
Second Line	:	STE 100, BOX 65
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-4329
Country	:	US
Telephone Number	:	314-202-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	8651 HWY N
Second Line	:	STE 100, BOX 65
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-4329
Country	:	US
Telephone Number	:	314-202-4026
Fax Number	:

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

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	02/07/2025

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