Provider Demographics
NPI:1962470021
Name:LINDHORST, LELIA K (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LELIA
Middle Name:K
Last Name:LINDHORST
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6302
Mailing Address - Country:US
Mailing Address - Phone:314-628-6550
Mailing Address - Fax:314-514-9910
Practice Address - Street 1:970 EXECUTIVE PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6302
Practice Address - Country:US
Practice Address - Phone:314-628-6550
Practice Address - Fax:314-514-9910
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010078691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1962470021Medicaid
MO1962470021Medicaid