Provider Demographics
NPI:1134267487
Name:FELDMAN, ELLEN BARRON (RN MA LPC)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:BARRON
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:RN MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PIPER HILL DR
Mailing Address - Street 2:STE 104
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-447-9250
Mailing Address - Fax:636-447-9249
Practice Address - Street 1:115 PIPER HILL DR
Practice Address - Street 2:STE 104
Practice Address - City:ST PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376
Practice Address - Country:US
Practice Address - Phone:636-447-9250
Practice Address - Fax:636-447-9249
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001738101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO117293OtherBCBS