Healthcare Provider Details

I. General information

NPI: 1790848661
Provider Name (Legal Business Name): ADRIENNE LEIGH CASEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63139-1101
US

IV. Provider business mailing address

1820 CLOVER LN
FLORISSANT MO
63031-8437
US

V. Phone/Fax

Practice location:
  • Phone: 314-534-9350
  • Fax: 314-533-6047
Mailing address:
  • Phone: 314-306-2968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2004011201
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004011201
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: