Healthcare Provider Details

I. General information

NPI: 1689247678
Provider Name (Legal Business Name): TALIB NASIR SALAAM PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E 10TH ST
ROLLA MO
65401-3648
US

IV. Provider business mailing address

4020 LINDELL BLVD APT 101
SAINT LOUIS MO
63108-3230
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax: 660-885-3690
Mailing address:
  • Phone: 314-365-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2025010926
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: