Healthcare Provider Details

I. General information

NPI: 1609224971
Provider Name (Legal Business Name): INIZIO COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 SUNSET OFFICE DR STE L108
SAINT LOUIS MO
63127-1025
US

IV. Provider business mailing address

10805 SUNSET OFFICE DR STE L108
SAINT LOUIS MO
63127-1025
US

V. Phone/Fax

Practice location:
  • Phone: 314-775-9289
  • Fax:
Mailing address:
  • Phone: 314-775-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2001001599
License Number StateMO

VIII. Authorized Official

Name: MS. DENISE ANN MORGAN
Title or Position: OWNER / LICENSED PROFESSIONAL COUNS
Credential: LPC
Phone: 314-775-9289