Provider Demographics
NPI:1902919442
Name:VIETMEIER INTEGRATIVE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:VIETMEIER INTEGRATIVE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VIETMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:636-338-4374
Mailing Address - Street 1:155 ZALABAK RD
Mailing Address - Street 2:
Mailing Address - City:HAWK POINT
Mailing Address - State:MO
Mailing Address - Zip Code:63349-1902
Mailing Address - Country:US
Mailing Address - Phone:636-338-4374
Mailing Address - Fax:636-338-4731
Practice Address - Street 1:155 ZALABAK RD
Practice Address - Street 2:
Practice Address - City:HAWK POINT
Practice Address - State:MO
Practice Address - Zip Code:63349-1902
Practice Address - Country:US
Practice Address - Phone:636-338-4374
Practice Address - Fax:636-338-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030150671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013993Medicare PIN