Provider Demographics
NPI:1790095107
Name:WOLF, MONICA ELIZABETH (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELIZABETH
Last Name:WOLF
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-4111
Mailing Address - Country:US
Mailing Address - Phone:573-517-1690
Mailing Address - Fax:
Practice Address - Street 1:204 METRO DR STE B
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4408
Practice Address - Country:US
Practice Address - Phone:573-634-4591
Practice Address - Fax:573-634-4592
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010033057101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO02031983OtherDATE OF BIRTH