Provider Demographics
NPI:1770818015
Name:SCHNURBUSCH, LESA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESA
Middle Name:MARIE
Last Name:SCHNURBUSCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LESA
Other - Middle Name:MARIE
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 WATSON RD
Mailing Address - Street 2:SUITE G101
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1528
Mailing Address - Country:US
Mailing Address - Phone:314-367-5500
Mailing Address - Fax:314-843-0552
Practice Address - Street 1:498 WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4144
Practice Address - Country:US
Practice Address - Phone:636-391-9966
Practice Address - Fax:636-394-4678
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090058921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1770818015Medicaid