1124288220 NPI number — MRS. ANGELA LEE SKURTU LMFT

Table of content: MRS. ANGELA LEE SKURTU LMFT (NPI 1124288220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124288220 NPI number — MRS. ANGELA LEE SKURTU LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKURTU
Provider First Name:
ANGELA
Provider Middle Name:
LEE
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:
MURRAY
Provider Other First Name:
ANGELA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124288220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13610 BARRETT OFFICE DRIVE
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63021-7818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-973-7997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13610 BARRETT OFFICE DRIVE SUITE 214
Provider Second Line Business Practice Location Address:
ST. LOUIS MARRIAGE THERAPY, ANGELA SKURTU
Provider Business Practice Location Address City Name:
BALLWIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63021-7818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-973-7997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2008

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: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 2011031894 , 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)