Healthcare Provider Details

I. General information

NPI: 1598147555
Provider Name (Legal Business Name): JILL HARDING MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 S GRAND BLVD
SAINT LOUIS MO
63118-1033
US

IV. Provider business mailing address

4991 MAGNOLIA AVE
SAINT LOUIS MO
63139-1025
US

V. Phone/Fax

Practice location:
  • Phone: 314-717-1780
  • Fax:
Mailing address:
  • Phone: 314-717-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2014032305
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2014032305
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014032305
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: