Healthcare Provider Details

I. General information

NPI: 1669904199
Provider Name (Legal Business Name): BRITTANY BAGY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 DOUGHERTY FERRY RD STE 201
SAINT LOUIS MO
63122-3371
US

IV. Provider business mailing address

2705 DOUGHERTY FERRY RD STE 201
SAINT LOUIS MO
63122-3371
US

V. Phone/Fax

Practice location:
  • Phone: 314-239-7168
  • Fax:
Mailing address:
  • Phone: 314-239-7168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2009007181
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: