Healthcare Provider Details

I. General information

NPI: 1225386055
Provider Name (Legal Business Name): SARA KHALEDPOUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 5TH ST STE 201
SAINT CHARLES MO
63301-1808
US

IV. Provider business mailing address

400 N 5TH ST STE 201
SAINT CHARLES MO
63301-1808
US

V. Phone/Fax

Practice location:
  • Phone: 636-238-2615
  • Fax:
Mailing address:
  • Phone: 636-238-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019000814
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: