Healthcare Provider Details

I. General information

NPI: 1073706248
Provider Name (Legal Business Name): BRIAN GLEN STOREY D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 JUNCTION DR STE. B
GLEN CARBON IL
62034-4300
US

IV. Provider business mailing address

518 OAK VALLEY DR
SAINT LOUIS MO
63131-4730
US

V. Phone/Fax

Practice location:
  • Phone: 618-659-1606
  • Fax: 314-835-1016
Mailing address:
  • Phone: 314-580-7233
  • Fax: 314-835-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number3755
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number3755
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number300086
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: