Healthcare Provider Details

I. General information

NPI: 1356839344
Provider Name (Legal Business Name): MOLLY CLARE BERRA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 ARNOLD CROSSROADS CTR
ARNOLD MO
63010-1402
US

IV. Provider business mailing address

9806 BIG BEND BLVD
SAINT LOUIS MO
63122-6568
US

V. Phone/Fax

Practice location:
  • Phone: 314-600-6839
  • Fax:
Mailing address:
  • Phone: 314-600-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018028481
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: