Healthcare Provider Details

I. General information

NPI: 1104783158
Provider Name (Legal Business Name): SEASONS COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 STRAUSS DR
PARK HILLS MO
63601-2400
US

IV. Provider business mailing address

1590 CEDAR VALLEY DR
BONNE TERRE MO
63628-4021
US

V. Phone/Fax

Practice location:
  • Phone: 573-701-1675
  • Fax:
Mailing address:
  • Phone: 573-701-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LEE A ROBERTS
Title or Position: CEO
Credential: LCSW
Phone: 573-701-1675