Provider Demographics
NPI:1972198232
Name:VINTES, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VINTES
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 1:713 WILLOW SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2069
Mailing Address - Country:US
Mailing Address - Phone:618-795-0639
Mailing Address - Fax:
Practice Address - Street 1:8008 CARONDELET AVE STE 308
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1724
Practice Address - Country:US
Practice Address - Phone:618-795-0639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021006574101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional