Provider Demographics
NPI:1083379507
Name:ST LOUIS, ENEARAY
Entity Type:Individual
Prefix:MRS
First Name:ENEARAY
Middle Name:
Last Name:ST LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 PUMPHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-3434
Mailing Address - Country:US
Mailing Address - Phone:315-706-5474
Mailing Address - Fax:
Practice Address - Street 1:283 W 2ND ST STE 1
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3812
Practice Address - Country:US
Practice Address - Phone:315-342-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health