Basic Information
| Provider Information | |||||||||
| NPI: | 1003806662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIEHAUS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 VANCE RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630881575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362253700 | ||||||||
| FaxNumber: | 6362253709 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 VANCE RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | VALLEY PARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630881575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362253700 | ||||||||
| FaxNumber: | 6362253709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 12/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 2000150484 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.