Provider Demographics
NPI:1356513824
Name:AWTREY, STEVEN MAX (LPC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MAX
Last Name:AWTREY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N IOLA DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2226
Mailing Address - Country:US
Mailing Address - Phone:314-968-2216
Mailing Address - Fax:314-968-2335
Practice Address - Street 1:7955 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2703
Practice Address - Country:US
Practice Address - Phone:314-968-2216
Practice Address - Fax:314-968-2335
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001011550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health