Provider Demographics
NPI:1043061013
Name:RAZA, NADIA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:RAZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S MOKANE CT APT 304
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4292
Mailing Address - Country:US
Mailing Address - Phone:314-614-0098
Mailing Address - Fax:
Practice Address - Street 1:230 S BEMISTON AVE STE 920
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1997
Practice Address - Country:US
Practice Address - Phone:800-353-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023015710101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional