Healthcare Provider Details

I. General information

NPI: 1902893589
Provider Name (Legal Business Name): MARY C OBOWA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 LADUE RD
SAINT LOUIS MO
63141-8120
US

IV. Provider business mailing address

12141 LADUE RD
SAINT LOUIS MO
63141-8120
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-1097
  • Fax: 314-878-4524
Mailing address:
  • Phone: 314-336-1097
  • Fax: 314-878-4524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCS001545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: