Healthcare Provider Details

I. General information

NPI: 1760802318
Provider Name (Legal Business Name): WARM LIGHT COUNSELING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WOODRIDGE DR
PEVELY MO
63070-1939
US

IV. Provider business mailing address

8701 WOODRIDGE DR
PEVELY MO
63070-1939
US

V. Phone/Fax

Practice location:
  • Phone: 636-556-0474
  • Fax:
Mailing address:
  • Phone: 636-556-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2008032689
License Number StateMO

VIII. Authorized Official

Name: MR. JOHN WESLEY HARPOLE JR.
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 636-556-0747