Healthcare Provider Details

I. General information

NPI: 1073099404
Provider Name (Legal Business Name): CELEBRATIONPOINTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 HOWDERSHELL RD
HAZELWOOD MO
63042-1170
US

IV. Provider business mailing address

4166 LINDELL BLVD STE 1B
SAINT LOUIS MO
63108-2923
US

V. Phone/Fax

Practice location:
  • Phone: 314-942-9499
  • Fax:
Mailing address:
  • Phone: 314-580-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARVIN SHELTON
Title or Position: CEO
Credential:
Phone: 314-580-3029