Lisa S Dierdorf, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2015019936 Issued in MO

Practice address

301 Sovereign CT Ste 211
Ballwin, MO 63011-4435

Phone

(636) 346-1132

NPI assigned

Mar 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

St. Louis Behavioral Medicine Institute IncGroup PAC ID 3173428638, 67 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Louis Behavioral Medicine Institute Inc

  • Psychologist
  • Saint Louis, MO
  • NPI 1487732335
  Medicare reassignment Care Compare group NPD
• St. Louis Behavioral Medicine Institute Inc

  • Mental Health Counselor
  • Fairview Heights, IL
  • NPI 1952169179
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627948800000",
    "number": "1568047769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SOVEREIGN CT STE 211",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114435",
            "telephone_number": "636-346-1132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SOVEREIGN CT STE 211",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114435",
            "telephone_number": "636-346-1132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERDORF",
        "first_name": "LISA",
        "middle_name": "S",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MO",
            "license": "2015019936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Monique Delutis, DPM
• Luann Carmody Denten, LPC
• Laura G Denunzio, MD
• Rachel Anne Dickerson, M.D.
• Dierbergs Markets Inc
• Jordan Dietl, OT
• Sandra Diver, LCSW
• Katherine G Dodge, DPT
• Robbin R Doermer, D.C.
• Carla Mary Doherty, RPH

• Professional Counselor in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Professional Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.