Provider Demographics
NPI:1093024044
Name:LUTEN KARANDJEFF, ALICE (PHD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:LUTEN KARANDJEFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 CLAYTON RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1342
Mailing Address - Country:US
Mailing Address - Phone:314-440-4165
Mailing Address - Fax:
Practice Address - Street 1:7750 CLAYTON RD STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1342
Practice Address - Country:US
Practice Address - Phone:314-440-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010030792103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23-2812942OtherST LOUIS BEHAVIORAL MEDICINE INSTITUTE