Provider Demographics
NPI:1396966883
Name:PASCH, MITZI S (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:S
Last Name:PASCH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 PEPPER VIEW CT.
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:314-703-3999
Mailing Address - Fax:636-532-0470
Practice Address - Street 1:1 HILLTOP VILLAGE CENTER
Practice Address - Street 2:STE. 3A
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025
Practice Address - Country:US
Practice Address - Phone:314-703-3999
Practice Address - Fax:636-532-0470
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060033631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical