Provider Demographics
NPI:1881310084
Name:PATERSON, EMILIE J (MA, LPC)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:J
Last Name:PATERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 SCARSDALE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-5403
Mailing Address - Country:US
Mailing Address - Phone:205-531-8347
Mailing Address - Fax:
Practice Address - Street 1:400 N 5TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-1808
Practice Address - Country:US
Practice Address - Phone:636-277-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MO2021039444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty