MEDICARE: HEALING STREAMS COUNSELING, 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	:	1528612744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING STREAMS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	4255 GREENSBORO DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63304-1612
Country	:	US
Telephone Number	:	314-629-3374
Fax Number	:	636-224-3160

Provider Business Practice Location Address
First Line	:	1033 CORPORATE SQUARE DR # 105
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:	314-643-7444
Fax Number	:	636-224-3160

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MRS. DAMARIS KARANJA
Credential	:	LPC, RDN
Telephone Number	:	314-629-3374

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	07/25/2019

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