Provider Demographics
NPI:1245937127
Name:TREADWAY, LARONDA (LPC)
Entity type:Individual
Prefix:
First Name:LARONDA
Middle Name:
Last Name:TREADWAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IL
Mailing Address - Zip Code:62060-1441
Mailing Address - Country:US
Mailing Address - Phone:314-599-4657
Mailing Address - Fax:
Practice Address - Street 1:12 FEE FEE RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2729
Practice Address - Country:US
Practice Address - Phone:314-368-2409
Practice Address - Fax:949-577-4014
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2022045386OtherPROFESSIONAL LICENSE