Healthcare Provider Details
I. General information
NPI: 1982256418
Provider Name (Legal Business Name): CHANGING YOUR BELIEFS TO A BETTER LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/15/2019
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2536 S OLD HIGHWAY 94 STE 120
SAINT CHARLES MO
63303-5627
US
IV. Provider business mailing address
3252 MEADOW TRAIL DR
SAINT PETERS MO
63376-7575
US
V. Phone/Fax
- Phone: 314-825-7905
- Fax:
- Phone: 314-825-7905
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MS.
NANCY
J
MESEY
Title or Position: LPC
Credential: LPC
Phone: 314-825-7905