Healthcare Provider Details

I. General information

NPI: 1538988134
Provider Name (Legal Business Name): OUROBOROS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 S JEFFERSON AVE # 10
SAINT LOUIS MO
63118-3119
US

IV. Provider business mailing address

1123 LOCUST ST STE 237
SAINT LOUIS MO
63101-1103
US

V. Phone/Fax

Practice location:
  • Phone: 314-312-1206
  • Fax:
Mailing address:
  • Phone: 361-945-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITAIN SHAW
Title or Position: OWNER
Credential: LPC
Phone: 361-945-8382