Provider Demographics
NPI:1063426161
Name:HART, JOHN THOMAS (MED, LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:THOMAS
Last Name:HART
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 MANCHESTER RD
Mailing Address - Street 2:SUTIE 182
Mailing Address - City:DES PERES
Mailing Address - State:MO
Mailing Address - Zip Code:63131-4423
Mailing Address - Country:US
Mailing Address - Phone:314-488-0098
Mailing Address - Fax:314-821-2402
Practice Address - Street 1:12015 MANCHESTER RD
Practice Address - Street 2:SUITE 182
Practice Address - City:DES PERES
Practice Address - State:MO
Practice Address - Zip Code:63131-4423
Practice Address - Country:US
Practice Address - Phone:314-488-0098
Practice Address - Fax:314-821-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000152900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health