Healthcare Provider Details

I. General information

NPI: 1407723810
Provider Name (Legal Business Name): WELLNESS ON CALL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8274 GLEN ECHO DR
SAINT LOUIS MO
63121-4552
US

IV. Provider business mailing address

8274 GLEN ECHO DR
SAINT LOUIS MO
63121-4552
US

V. Phone/Fax

Practice location:
  • Phone: 314-252-0245
  • Fax: 314-463-4029
Mailing address:
  • Phone: 314-252-0245
  • Fax: 314-463-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LORI A CALLOWAY
Title or Position: OWNER
Credential: NP
Phone: 314-252-0245