MEDICARE: UNIVERSAL COUNSELING SERVICES, 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	251S00000X	Community/Behavioral Health Agency	2013035767	MO

General Provider Information

NPI Number	:	1982071338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1623 JEFFCO BLVD
Second Line	:	SUITE 206
City	:	ARNOLD
State	:	MO
Zip	:	63010-2737
Country	:	US
Telephone Number	:	636-222-1573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 JEFFCO BLVD
Second Line	:	SUITE 206
City	:	ARNOLD
State	:	MO
Zip	:	63010-2737
Country	:	US
Telephone Number	:	636-222-1573
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	JENNIFER KAY ERVIN-CALL
Credential	:	LCSW
Telephone Number	:	636-222-1573

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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