Provider Demographics
NPI:1760934905
Name:LASHER CONSUMER DIRECTED SERVICES, LLC
Entity Type:Organization
Organization Name:LASHER CONSUMER DIRECTED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-801-8651
Mailing Address - Street 1:2138 WOODSON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63114-5671
Mailing Address - Country:US
Mailing Address - Phone:314-801-8650
Mailing Address - Fax:314-801-8651
Practice Address - Street 1:2138 WOODSON RD STE 1
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63114-5671
Practice Address - Country:US
Practice Address - Phone:314-801-8650
Practice Address - Fax:314-801-8651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO814249751Medicaid