Provider Demographics
NPI:1063237857
Name:VEGA, RITA ELISA (PLPC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:ELISA
Last Name:VEGA
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 SWEETCREEK DR APT F
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-4856
Mailing Address - Country:US
Mailing Address - Phone:573-808-6071
Mailing Address - Fax:
Practice Address - Street 1:13100 MANCHESTER RD STE 450
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1703
Practice Address - Country:US
Practice Address - Phone:314-577-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024044869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health