Provider Demographics
NPI:1669207262
Name:LANDGREBE, OLIVIA (LPC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:LANDGREBE
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 1:5083 MILENTZ AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-3514
Mailing Address - Country:US
Mailing Address - Phone:636-221-4270
Mailing Address - Fax:
Practice Address - Street 1:5083 MILENTZ AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3514
Practice Address - Country:US
Practice Address - Phone:636-221-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2021051199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional