Healthcare Provider Details

I. General information

NPI: 1740744499
Provider Name (Legal Business Name): SANDRA MABEL STEELE-RENDON LCSW MENTAL HEALTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE LOWR LEVEL
SAINT LOUIS MO
63117-1851
US

IV. Provider business mailing address

5069 LINDENWOOD AVE
SAINT LOUIS MO
63109-1728
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-8056
  • Fax:
Mailing address:
  • Phone: 314-704-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2017034637
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2017034637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: