1033280144 NPI number — MRS. ELLEN MARTING JAYAPRABHU LMFT

Table of content: MRS. ELLEN MARTING JAYAPRABHU LMFT (NPI 1033280144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033280144 NPI number — MRS. ELLEN MARTING JAYAPRABHU LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JAYAPRABHU
Provider First Name:
ELLEN
Provider Middle Name:
MARTING
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTING
Provider Other First Name:
ELLEN
Provider Other Middle Name:
ANDERSON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033280144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6362 ALAMO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63105-3104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-583-2242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 N NEW BALLAS RD STE 285
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63141-6877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-635-6505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2006

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: 106H00000X , with the licence number:  2006030663 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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