Provider Demographics
NPI:1275993362
Name:WILLETT, GENEVIEVE (LPC)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 KAIN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4333
Mailing Address - Country:US
Mailing Address - Phone:314-623-4004
Mailing Address - Fax:
Practice Address - Street 1:8780 BIG BEND BLVD STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3774
Practice Address - Country:US
Practice Address - Phone:314-623-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010038929101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional