Healthcare Provider Details

I. General information

NPI: 1952786733
Provider Name (Legal Business Name): HALSTON ELEXIS HUTCHISON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 01/09/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8045 BIG BEND BLVD STE 101
SAINT LOUIS MO
63119-2714
US

IV. Provider business mailing address

PO BOX #300098
SAINT LOUIS MO
63130-9998
US

V. Phone/Fax

Practice location:
  • Phone: 314-722-5808
  • Fax:
Mailing address:
  • Phone: 314-722-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2023004091
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: