Provider Demographics
NPI:1790934032
Name:SYKES, ANNETTA
Entity Type:Individual
Prefix:MISS
First Name:ANNETTA
Middle Name:
Last Name:SYKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9823 MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1943
Mailing Address - Country:US
Mailing Address - Phone:314-629-2889
Mailing Address - Fax:314-454-3991
Practice Address - Street 1:7750 CLAYTON RD
Practice Address - Street 2:103
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1353
Practice Address - Country:US
Practice Address - Phone:314-647-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008010317101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor