Healthcare Provider Details

I. General information

NPI: 1770662199
Provider Name (Legal Business Name): CENTER FOR COUNSELING AND PASTORAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7680 LINDBERGH DR
RICHMOND HEIGHTS MO
63117-2138
US

IV. Provider business mailing address

7680 LINDBERGH DR
RICHMOND HEIGHTS MO
63117-2138
US

V. Phone/Fax

Practice location:
  • Phone: 636-527-7615
  • Fax: 636-527-7635
Mailing address:
  • Phone: 636-527-7615
  • Fax: 636-527-7635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number2004029338
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-000873
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-002690
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004029338
License Number StateMO

VIII. Authorized Official

Name: MS. LINDA A. HORRELL
Title or Position: EXECUTIVE DIRECTOR
Credential: M.DIV, MSW
Phone: 636-527-7615