Provider Demographics
NPI:1942536503
Name:THAYER, ELAINE SR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:THAYER
Suffix:SR
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12813 FLUSHING MEADOWS DR
Mailing Address - Street 2:STE 140
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1835
Mailing Address - Country:US
Mailing Address - Phone:314-712-8354
Mailing Address - Fax:314-872-8033
Practice Address - Street 1:12813 FLUSHING MEADOWS DR
Practice Address - Street 2:STE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1835
Practice Address - Country:US
Practice Address - Phone:314-712-8354
Practice Address - Fax:314-872-8033
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0005491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical