Healthcare Provider Details

I. General information

NPI: 1669367348
Provider Name (Legal Business Name): BRENDAN BENN TEMPLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 LADUE RD
CREVE COEUR MO
63141-8120
US

IV. Provider business mailing address

2650 OLIVE ST
SAINT LOUIS MO
63103-1489
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-0100
  • Fax:
Mailing address:
  • Phone: 314-802-2615
  • Fax: 314-842-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178013219
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020011784
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: