Provider Demographics
NPI:1922630771
Name:GARLAND, ELISA STEPHANIE (PLPC)
Entity Type:Individual
Prefix:MS
First Name:ELISA
Middle Name:STEPHANIE
Last Name:GARLAND
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JEWISH FAMILY & CHILDREN'S SERVICE
Mailing Address - Street 2:10950 SCHUETZ ROAD
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-812-9348
Mailing Address - Fax:314-812-9398
Practice Address - Street 1:10950 SCHUETZ RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5704
Practice Address - Country:US
Practice Address - Phone:314-812-9348
Practice Address - Fax:314-812-9398
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019004839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2014010090Medicaid