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Individual

ELIZABETH JEREMIAH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, QMHP, LCPC, LPHA

Contact information

Practice address
1161 FORTUNE BLVD STE 400, SHILOH, IL 62269-7385
(618) 303-7544
(618) 206-8476
Mailing address
6432 HANCOCK AVE, SAINT LOUIS, MO 63139-2033
(618) 303-7544
(618) 206-8476

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180.009474
IL
101YM0800X
Mental Health Counselor
180.009474
IL

Other

Enumeration date
01/27/2015
Last updated
01/24/2020
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