Provider Demographics
NPI:1477380384
Name:MATHER, ABIGAIL (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MATHER
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 EXECUTIVE PARKWAY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6369
Mailing Address - Country:US
Mailing Address - Phone:314-469-5522
Mailing Address - Fax:
Practice Address - Street 1:1000 EXECUTIVE PARKWAY DR STE 106
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6369
Practice Address - Country:US
Practice Address - Phone:314-469-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional