Healthcare Provider Details

I. General information

NPI: 1952901688
Provider Name (Legal Business Name): COMMUNITY REACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 PENNRIDGE DR STE 119
BRIDGETON MO
63044-1244
US

IV. Provider business mailing address

3751 PENNRIDGE DR STE 119
BRIDGETON MO
63044-1244
US

V. Phone/Fax

Practice location:
  • Phone: 314-443-7776
  • Fax:
Mailing address:
  • Phone: 314-443-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: EBONY HUTCHINSON
Title or Position: OWNER
Credential: LCSW
Phone: 314-449-7776