Healthcare Provider Details

I. General information

NPI: 1568700276
Provider Name (Legal Business Name): ST. LOUIS ADDICTION COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7954 BIG BEND BLVD SUITE E
SAINT LOUIS MO
63119-2717
US

IV. Provider business mailing address

7954 BIG BEND BLVD SUITE E
SAINT LOUIS MO
63119-2717
US

V. Phone/Fax

Practice location:
  • Phone: 314-677-7808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY DAVID ZEHNLE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 314-435-6963