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Provider Information for 1972089274


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SUSAN COREY HART MA, LPC


Sex: Female

NPI: 1972089274
Last Updated: 2018-07-19
Certification Date:

Details

NameValue
NPI1972089274
Enumeration Date2018-07-19
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 2536 S OLD HIGHWAY 94 STE 234
SAINT CHARLES, MO 63303-5612
United States

Phone: 636-284-6082 | Fax:
 
Primary Practice Address 2536 S OLD HIGHWAY 94 STE 234
SAINT CHARLES, MO 63303-5612
United States

Phone: 636-284-6082 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YP2500X - Counselor - ProfessionalMO2012024648