Provider Demographics
NPI:1891802534
Name:KAUFMAN-YAVITZ, LOUISE (MS,LPC,LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:KAUFMAN-YAVITZ
Suffix:
Gender:F
Credentials:MS,LPC,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 OLIVETTE EXECUTIVE PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3254
Mailing Address - Country:US
Mailing Address - Phone:314-872-9988
Mailing Address - Fax:314-872-8033
Practice Address - Street 1:1121 OLIVETTE EXECUTIVE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3254
Practice Address - Country:US
Practice Address - Phone:314-872-9988
Practice Address - Fax:314-872-8033
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLPC 00431174400000X
MOLCSW 000446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00078301Medicare ID - Type Unspecified