Provider Demographics
NPI:1487058624
Name:MEJIA, KATHY ANNE (PLPC)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANNE
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:ANNE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9666 OLIVE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3013
Mailing Address - Country:US
Mailing Address - Phone:636-448-7642
Mailing Address - Fax:
Practice Address - Street 1:9666 OLIVE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3013
Practice Address - Country:US
Practice Address - Phone:636-448-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033730101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor