Healthcare Provider Details

I. General information

NPI: 1497550974
Provider Name (Legal Business Name): KARIS HOUSE COMMUNITY COUNSELING NETOWRK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 05/21/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MERAMEC STATION RD
MANCHESTER MO
63021-5550
US

IV. Provider business mailing address

625 MERAMEC STATION RD
MANCHESTER MO
63021-5550
US

V. Phone/Fax

Practice location:
  • Phone: 314-266-6148
  • Fax:
Mailing address:
  • Phone: 314-266-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMY MATTIA
Title or Position: EXECUTIVE DIRECTOR
Credential: MA LPC
Phone: 314-266-6148