Healthcare Provider Details

I. General information

NPI: 1356205579
Provider Name (Legal Business Name): MRS. SHANTA KANICA MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N HIGHWAY 67 ST
FLORISSANT MO
63031-2915
US

IV. Provider business mailing address

845 N HIGHWAY 67 ST
FLORISSANT MO
63031-2915
US

V. Phone/Fax

Practice location:
  • Phone: 314-518-5530
  • Fax: 314-300-8114
Mailing address:
  • Phone: 314-518-5530
  • Fax: 314-300-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: