Provider Demographics
NPI:1750517546
Name:LUTHRA, NIMISHA (LPC (PROVISIONAL))
Entity type:Individual
Prefix:MISS
First Name:NIMISHA
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:LPC (PROVISIONAL)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 362B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-849-0450
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 362B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-849-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPROVISIONAL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health