Provider Demographics
NPI:1184773285
Name:GREER, STACEY NENTWIG (MED)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:NENTWIG
Last Name:GREER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 N NEW BALLAS RD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6814
Mailing Address - Country:US
Mailing Address - Phone:314-999-1566
Mailing Address - Fax:314-991-0666
Practice Address - Street 1:425 N NEW BALLAS RD
Practice Address - Street 2:SUITE 195
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6814
Practice Address - Country:US
Practice Address - Phone:314-999-1566
Practice Address - Fax:314-991-0666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional