1265528921 NPI number — ADRIENNE ELOIS CALVERT LPC

Table of content: ADRIENNE ELOIS CALVERT LPC (NPI 1265528921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265528921 NPI number — ADRIENNE ELOIS CALVERT LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALVERT
Provider First Name:
ADRIENNE
Provider Middle Name:
ELOIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPEARS
Provider Other First Name:
ADRIENNE
Provider Other Middle Name:
ELOIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265528921
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 HWY VV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNETT
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-888-5925
Provider Business Mailing Address Fax Number:
573-888-9365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 HWY VV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNETT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-888-5925
Provider Business Practice Location Address Fax Number:
573-888-9365
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 497182709 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 918435 . This is a "HEALTHLINK HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1622156 . This is a "FIRST HEALTH/COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 918435 . This is a "HEALTHLINK PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11455956 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2721 . This is a "EAP IMPACT" identifier . This identifiers is of the category "OTHER".




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