Provider Demographics
NPI:1639294150
Name:HERMAN, ANN MARIE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MAIN ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-3306
Mailing Address - Country:US
Mailing Address - Phone:636-634-9912
Mailing Address - Fax:636-947-5941
Practice Address - Street 1:820 S MAIN ST
Practice Address - Street 2:SUITE 307
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-3306
Practice Address - Country:US
Practice Address - Phone:636-634-9912
Practice Address - Fax:636-947-5941
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001001545101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional