Healthcare Provider Details

I. General information

NPI: 1255003000
Provider Name (Legal Business Name): OSAGE VALLEY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
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 TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MIRRANDA CARDINALI
Title or Position: OWNER/OPERATOR
Credential: LPC, CRC
Phone: 636-600-0446