Healthcare Provider Details

I. General information

NPI: 1497527535
Provider Name (Legal Business Name): REBECCA IHLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 GRAVOIS RD STE L100
FENTON MO
63026-4134
US

IV. Provider business mailing address

12852 SHADOW LN
SAINT LOUIS MO
63127-1523
US

V. Phone/Fax

Practice location:
  • Phone: 636-496-7344
  • Fax: 573-803-1405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2025050663
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: