Healthcare Provider Details

I. General information

NPI: 1003587635
Provider Name (Legal Business Name): JENNA MASTERS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 09/23/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CLIFF CAVE RD STE 200
SAINT LOUIS MO
63129-3646
US

IV. Provider business mailing address

3127 TUSCAN VALLEY ESTATES CT
ARNOLD MO
63010-2505
US

V. Phone/Fax

Practice location:
  • Phone: 314-827-8732
  • Fax:
Mailing address:
  • Phone: 314-827-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2021030439
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: