Healthcare Provider Details

I. General information

NPI: 1932662228
Provider Name (Legal Business Name): SHELBY ZURICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 11/12/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKINGS DR
SAINT LOUIS MO
63130-4862
US

IV. Provider business mailing address

1 BROOKINGS DR MSC-1201-323-100
SAINT LOUIS MO
63130-4862
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6666
  • Fax: 314-696-1214
Mailing address:
  • Phone: 314-935-6666
  • Fax: 314-696-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2019009770
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: