Provider Demographics
NPI:1902248222
Name:WINTERS, ELIZABETH SHEAHAN (MED, PLPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SHEAHAN
Last Name:WINTERS
Suffix:
Gender:F
Credentials:MED, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6639 WINONA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1219
Mailing Address - Country:US
Mailing Address - Phone:314-681-3096
Mailing Address - Fax:
Practice Address - Street 1:6639 WINONA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1219
Practice Address - Country:US
Practice Address - Phone:314-681-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013008707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional