MEDICARE: MARBLE WELLNESS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1891300570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARBLE WELLNESS

Provider Business Mailing Address
First Line	:	6314 S ROSEBURY AVE APT 1E
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-2255
Country	:	US
Telephone Number	:	636-236-2420
Fax Number	:

Provider Business Practice Location Address
First Line	:	11042 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-1244
Country	:	US
Telephone Number	:	636-236-2420
Fax Number	:

Authorized Official
Title or Position	:	OWNER & THERAPIST
Name	:	STEPHANIE KORPAL
Credential	:	M.ED., LPC
Telephone Number	:	636-236-2420

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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Directions to “MARBLE WELLNESS ” Practice Location

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