Healthcare Provider Details

I. General information

NPI: 1730208984
Provider Name (Legal Business Name): PSYCHOLOGICAL TESTING & COUNSELING ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7657 TERRI LYNN DR
SAINT LOUIS MO
63123-1674
US

IV. Provider business mailing address

141 N MERAMEC AVE SUITE 112
CLAYTON MO
63105-3750
US

V. Phone/Fax

Practice location:
  • Phone: 314-832-1077
  • Fax: 314-832-3037
Mailing address:
  • Phone: 314-832-1077
  • Fax: 314-832-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001759
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number00331
License Number StateMO

VIII. Authorized Official

Name: JOHN EDWARD O'BRIEN
Title or Position: PRESIDENT
Credential:
Phone: 314-832-1077