Provider Demographics
NPI:1013584200
Name:PRICE, MALLORY JORDAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:JORDAN
Last Name:PRICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:HAMEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2800 S GRAND BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1007
Mailing Address - Country:US
Mailing Address - Phone:636-290-4441
Mailing Address - Fax:
Practice Address - Street 1:16216 BAXTER RD STE 205
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4778
Practice Address - Country:US
Practice Address - Phone:636-532-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210178531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical