Provider Demographics
NPI:1609603984
Name:LAND, EMILY WILSON (PLPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:WILSON
Last Name:LAND
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 CLAYTON RD APT 2W
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1860
Mailing Address - Country:US
Mailing Address - Phone:704-775-6628
Mailing Address - Fax:
Practice Address - Street 1:1000 EXECUTIVE PARKWAY DR STE 106
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6369
Practice Address - Country:US
Practice Address - Phone:314-469-5522
Practice Address - Fax:314-469-5504
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024034637101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor