Provider Demographics
NPI:1033280144
Name:JAYAPRABHU, ELLEN MARTING (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARTING
Last Name:JAYAPRABHU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:ANDERSON
Other - Last Name:MARTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6362 ALAMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3104
Mailing Address - Country:US
Mailing Address - Phone:314-583-2242
Mailing Address - Fax:
Practice Address - Street 1:425 N NEW BALLAS RD STE 285
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6877
Practice Address - Country:US
Practice Address - Phone:314-635-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006030663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist