Healthcare Provider Details

I. General information

NPI: 1992174759
Provider Name (Legal Business Name): SANDHILL COUNSELING AND CONSULTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 11/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WOODLAWN AVE STE 15
O FALLON MO
63366-7647
US

IV. Provider business mailing address

801 WOODLAWN AVE STE 15
O FALLON MO
63366-7647
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-1779
  • Fax:
Mailing address:
  • Phone: 636-379-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2009005350
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2012013275
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007012820
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2008019002
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002559
License Number StateMO
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2009000406
License Number StateMO

VIII. Authorized Official

Name: MONICA LIESER
Title or Position: OWNER
Credential: LMFT, LPC
Phone: 636-379-1779