Healthcare Provider Details

I. General information

NPI: 1164949467
Provider Name (Legal Business Name): MATTHEW E CAUBLE MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9666 OLIVE BLVD STE 510
SAINT LOUIS MO
63132-3026
US

IV. Provider business mailing address

9666 OLIVE BLVD STE 510
SAINT LOUIS MO
63132-3026
US

V. Phone/Fax

Practice location:
  • Phone: 618-722-3079
  • Fax:
Mailing address:
  • Phone: 618-722-3079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2022003264
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: