Provider Demographics
NPI:1952918724
Name:VARGHESE, ANNA (MA, NCC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 GIBSON AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1519
Mailing Address - Country:US
Mailing Address - Phone:678-778-7654
Mailing Address - Fax:
Practice Address - Street 1:1402 SILVERTON PL
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-2216
Practice Address - Country:US
Practice Address - Phone:618-973-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional