Healthcare Provider Details

I. General information

NPI: 1124503271
Provider Name (Legal Business Name): MIRRANDA CARDINALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 WESTPARK CTR DR STE 100
FENTON MO
63026-1916
US

IV. Provider business mailing address

1736 WESTPARK CTR DR STE 100
FENTON MO
63026-1916
US

V. Phone/Fax

Practice location:
  • Phone: 636-600-0446
  • Fax: 636-660-2262
Mailing address:
  • Phone: 636-600-0446
  • Fax: 636-660-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number2018006449
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018006449
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: