Healthcare Provider Details

I. General information

NPI: 1083553069
Provider Name (Legal Business Name): IJB THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63109-2924
US

IV. Provider business mailing address

5219 S KINGSHIGHWAY BLVD
SAINT LOUIS MO
63109-2924
US

V. Phone/Fax

Practice location:
  • Phone: 314-246-0710
  • Fax:
Mailing address:
  • Phone: 314-246-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: IRENA BARTNICK
Title or Position: THERAPIST
Credential: BARTNICK
Phone: 314-583-2321