Healthcare Provider Details

I. General information

NPI: 1306634886
Provider Name (Legal Business Name): LIFE RESTORATION COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WALL ST STE 231
SAINT CHARLES MO
63303-3546
US

IV. Provider business mailing address

1550 WALL ST STE 231
SAINT CHARLES MO
63303-3546
US

V. Phone/Fax

Practice location:
  • Phone: 636-293-0044
  • Fax: 636-724-6349
Mailing address:
  • Phone: 636-293-0044
  • Fax: 636-724-6349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLORIA STEPHEN
Title or Position: OWNER
Credential: LPC
Phone: 636-293-0044