Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2001027653 | MO |
NPI | 1003015975 |
---|---|
Provider Name | Mr. Eric Dean Lindhorst |
First Address | Webster Groves, MO 63119-4814 |
Second Address | St. Louis, MO 63141-6340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 19/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431338511 | UNITY (01) | MO |