Provider Demographics
NPI:1811241441
Name:VAN DILLEN, EMMA LEE (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:LEE
Last Name:VAN DILLEN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:LEE
Other - Last Name:GODBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC-IT, SAC-IT
Mailing Address - Street 1:8651 HWY N
Mailing Address - Street 2:STE 100, BOX 65
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4329
Mailing Address - Country:US
Mailing Address - Phone:314-202-4026
Mailing Address - Fax:
Practice Address - Street 1:8651 HWY N
Practice Address - Street 2:STE 100, BOX 65
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-4329
Practice Address - Country:US
Practice Address - Phone:314-202-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024046605101YP2500X
WI1579226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional