Basic Information
| Provider Information | |||||||||
| NPI: | 1003015975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINDHORST | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 CHESHIRE LANE | ||||||||
| Address2: | |||||||||
| City: | WEBSTER GROVES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631194814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145371391 | ||||||||
| FaxNumber: | 3145964627 | ||||||||
| Practice Location | |||||||||
| Address1: | 1066 EXECUTIVE PARKWAY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145371391 | ||||||||
| FaxNumber: | 3145964627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2007 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2001027653 | MO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 431338511 | 01 | MO | UNITY | OTHER |