Provider Demographics
NPI:1750025508
Name:MEHLIG, MARK D (DMIN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:MEHLIG
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GEORGETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8550
Mailing Address - Country:US
Mailing Address - Phone:314-780-4678
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWATER POINT DRIVE STE 401
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-442-2612
Practice Address - Fax:636-265-2905
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical