Active NPI
Loren Gaillardetz
- Mental Health Counselor
- Maplewood, MO
National Provider Identifier
1164039103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 2019009357
- Practice address
- 3008 Sutton Blvd Ste 200
Maplewood, MO 63143-3064 - Phone
- (314) 328-4402
- NPI assigned
- Sep 24, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 2019009357 | MO | Primary |
Addresses
Primary practice location
3008 Sutton Blvd Ste 200
Maplewood, MO 63143-3064
Mailing address
6365 Clayton Rd
Clayton, MO 63117-1808
Phone (314) 328-4402
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019009357 | MO | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1600905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628208000000",
"number": "1164039103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6365 CLAYTON RD",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631171808",
"telephone_number": "314-328-4402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3008 SUTTON BLVD STE 200",
"city": "MAPLEWOOD",
"state": "MO",
"postal_code": "631433064",
"telephone_number": "314-328-4402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAILLARDETZ",
"first_name": "LOREN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-09-24",
"last_updated": "2021-08-06",
"certification_date": "2021-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MO",
"license": "2019009357",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.