Healthcare Provider Details

I. General information

NPI: 1225641673
Provider Name (Legal Business Name): UNITED CHRISTIAN COUNSELING SERVICE LLC
Entity Type: Organization
Gender: Male
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7733 FORSYTH BLVD FL 11
CLAYTON MO
63105-1878
US

IV. Provider business mailing address

7733 FORSYTH BLVD FL 11
CLAYTON MO
63105-1878
US

V. Phone/Fax

Practice location:
  • Phone: 314-485-9298
  • Fax:
Mailing address:
  • Phone: 314-485-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NOAH PHD LYLES PHD MFT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD MFT
Phone: 314-485-9298