Provider Demographics
NPI:1861512733
Name:MARSHA KAREN MOORE ANDREOFF
Entity type:Organization
Organization Name:MARSHA KAREN MOORE ANDREOFF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.P.C.
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:314-432-4556
Mailing Address - Street 1:9117 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1801
Mailing Address - Country:US
Mailing Address - Phone:314-432-1845
Mailing Address - Fax:
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 129 WEST
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-432-4556
Practice Address - Fax:314-997-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty