Provider Demographics
NPI:1427082395
Name:LUTHERAN FAMILY AND CHILDREN'S SERVICES OF MISSOURI
Entity type:Organization
Organization Name:LUTHERAN FAMILY AND CHILDREN'S SERVICES OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF PROGRAMS
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOERSTER
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LCSW
Authorized Official - Phone:314-754-2776
Mailing Address - Street 1:9666 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3013
Mailing Address - Country:US
Mailing Address - Phone:314-787-5100
Mailing Address - Fax:314-754-2800
Practice Address - Street 1:9666 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132
Practice Address - Country:US
Practice Address - Phone:314-787-5100
Practice Address - Fax:314-754-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990001149OtherMEDICARE PTAN
MO990001149Medicare ID - Type Unspecified