Healthcare Provider Details
I. General information
NPI: 1639708639
Provider Name (Legal Business Name): JOHN RAPP, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/02/2020
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
13975 MANCHESTER RD STE 2
BALLWIN MO
63011-4500
US
IV. Provider business mailing address
271 WYNSTAY AVE
VALLEY PARK MO
63088-1442
US
V. Phone/Fax
- Phone: 573-424-4808
- Fax:
- Phone: 314-456-9127
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name:
JOHN
GREGORY
RAPP
Title or Position: OWNER
Credential: LCSW
Phone: 314-456-9127