MEDICARE: MARY JO 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	101YP2500X	Professional Counselor	2002032337	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	197240	OTHER	MO	BCBS ID FOR LPC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891842860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO PRICE LPC

Provider Business Mailing Address
First Line	:	4801 WELDON SPRING PKWY
Second Line	:	STE. 300
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-9101
Country	:	US
Telephone Number	:	636-949-5760
Fax Number	:	636-949-0729

Provider Business Practice Location Address
First Line	:	4801 WELDON SPRING PKWY
Second Line	:	STE. 300
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-9101
Country	:	US
Telephone Number	:	636-949-5760
Fax Number	:	636-949-0729

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	10/14/2013

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Directions to “ MARY JO PRICE LPC” Practice Location

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