MEDICARE: ANNA VARGHESE MA, NCC

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

General Provider Information

NPI Number	:	1952918724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA VARGHESE MA, NCC

Provider Business Mailing Address
First Line	:	4515 GIBSON AVE UNIT A
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1519
Country	:	US
Telephone Number	:	678-778-7654
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 SILVERTON PL
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-2216
Country	:	US
Telephone Number	:	618-973-4863
Fax Number	:

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

Provider Enumeration Date	:	09/25/2020
Last Update Date	:	09/25/2020

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