Provider Demographics
NPI:1790001790
Name:NIEMANN, PEG ELIZABETH (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PEG
Middle Name:ELIZABETH
Last Name:NIEMANN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:PEG
Other - Middle Name:
Other - Last Name:NIEMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC, NCC
Mailing Address - Street 1:14377 WOODLAKE DR
Mailing Address - Street 2:SUITE 118
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5735
Mailing Address - Country:US
Mailing Address - Phone:314-205-1022
Mailing Address - Fax:
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:SUITE 118
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-205-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000167855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health