Healthcare Provider Details

I. General information

NPI: 1740469758
Provider Name (Legal Business Name): THERAPY AND BEYOND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 ELIZABETH ANNE LN
LABADIE MO
63055-1067
US

IV. Provider business mailing address

864 ELIZABETH ANNE LN
LABADIE MO
63055-1067
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-5588
  • Fax: 636-239-2275
Mailing address:
  • Phone: 636-239-5588
  • Fax: 636-239-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001828
License Number StateMO

VIII. Authorized Official

Name: DR. BRENDA SUE MELTON
Title or Position: MANAGER
Credential: RN, LPC
Phone: 636-239-5588