Healthcare Provider Details

I. General information

NPI: 1093625857
Provider Name (Legal Business Name): ALI CULLUM LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16020 SWINGLEY RIDGE RD STE 130
CHESTERFIELD MO
63017-2085
US

IV. Provider business mailing address

16020 SWINGLEY RIDGE RD STE 130
CHESTERFIELD MO
63017-2085
US

V. Phone/Fax

Practice location:
  • Phone: 314-717-1218
  • Fax:
Mailing address:
  • Phone: 314-717-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026040130
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: