MEDICARE: DUCK FALLS COUNSELING AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811655913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUCK FALLS COUNSELING AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1018 COUNTRY CLUB RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3364
Country	:	US
Telephone Number	:	314-471-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 COUNTRY CLUB RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3364
Country	:	US
Telephone Number	:	314-471-4445
Fax Number	:

Authorized Official
Title or Position	:	CEO, THERAPIST
Name	:	NICOLE FRANCES VINCIGUERRA
Credential	:	LCSW
Telephone Number	:	314-471-4445

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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