Healthcare Provider Details

I. General information

NPI: 1669598199
Provider Name (Legal Business Name): GREGORY N MEBRUER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7508 BIG BEND BLVD
SAINT LOUIS MO
63119-2104
US

IV. Provider business mailing address

92 ELK RUN DR
EUREKA MO
63025-1210
US

V. Phone/Fax

Practice location:
  • Phone: 314-722-8664
  • Fax:
Mailing address:
  • Phone: 314-722-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002013948
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: