MEDICARE: DRAGONFLY WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1346989266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGONFLY WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1600 HERITAGE LNDG STE 116
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63303-8490
Country	:	US
Telephone Number	:	636-345-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 HERITAGE LNDG STE 116
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63303-8490
Country	:	US
Telephone Number	:	636-345-1400
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KELLEY MOUNT
Credential	:	PH.D., LPC
Telephone Number	:	636-345-1400

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	05/31/2022

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Directions to “DRAGONFLY WELLNESS, LLC ” Practice Location

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